Psychosocial, cultural, and academic challenges to Saudi Arabian students in Australia.

OBJECTIVES: This study investigated the perceptions of Saudi Arabian medical disciplines students undergoing training in various institutes of Australia regarding psychosocial, cultural, and academic challenges.
METHODS: This cross-sectional study was from March 15 to June 15, 2019. Data were collected by an online questionnaire. It consisted of questions regarding demographic, psychosocial, cultural, and academic challenges. Two hundred nineteen students studying in Australia responded to our questionnaire.
RESULTS: Of the total 219 students, 13(6.0%) were undergraduate, 167(76%) were postgraduate, and 39(18%) were Ph.D. students. For most students (171[79.2%]), Australia was the country of choice for studying. Most of them were satisfied with their academic performance and adjustment to the Australian way of living. Most of the students (180[82.2%]) showed satisfaction over the availability of fair chances of their religious practices in Australia. Few of them faced difficulties coping with the Australian climate (25[11.4%]), homesickness (59[26.9%]), and food and dietary sources (44[20.1%]). Students were overall satisfied with the student advisory system (156[71.2%]), university assessments (147[67.2%]), and available research facilities (170[77.6%]). Among participants, 77 (35.1%), 119(54.3%), and 23(10.5%) students indicated that they wished to stay in Australia only until completion of their studies, temporarily and permanently, respectively.
CONCLUSIONS: Our findings showed that Saudi students in Australia had strong psychosocial well-being, cultural integration, and academic success. Most of them were satisfied and adjusted well to Australian culture.

Introduction

It has been an ancient tradition to travel to far-off countries to acquire knowledge. A lot of students travel across the world to acquire higher degrees. Similarly, medical students attend reputed teaching institutions throughout the world [1]. The Ministry of Education of the Kingdom of Saudi Arabia (KSA) sponsored 174333 students for education abroad in 2017 [2]. The figure shows the commitment and sincerity of the government to raise the number of learned citizens. When these students return after attaining higher qualifications, they assist in upgrading the academic standards in the Kingdom [3].

It has always been challenging for international students to settle down in a country with a different language and culture from their home country, especially when the educational set up is unfamiliar [4]. It is a difficult start when one is not accustomed to the norms of society. Moreover, international students may not understand the lectures and home assignments when there is a language barrier. In the case of interactive lectures, it becomes difficult for them to participate in active discussions and question answer-sessions in classes and ward rounds due to the language barrier, which may lead to lack of participation [5]. International students, especially medical undergraduates, and postgraduates are among the most successful students in their home countries after getting training from abroad [6]. This could be because of the better training opportunities and advanced technology available at the developed countries universities.

With the rapidly changing geopolitical circumstances, it is not easy to face religious challenges, especially for the Arab Muslim students, because, at times, some students on campus become very critical of specific religious beliefs [7]. It also becomes challenging to complete the assignments allotted to students with equal representation of female students where interaction is quite open and needs fluency in English [8]. However, most Saudi students are presently familiar with the importance of the English language, which has been adopted as a teaching language in most universities at home [9]. Students are supposed to attend interactive language courses before joining the international teaching institutes. Now they face fewer problems than their senior students who joined international institutes years back without proper English language coaching [10].

Australia is an open and tolerant society and much more welcoming than many western countries. International students, especially from Saudi Arabian backgrounds, may feel difficulties while adapting to a rather open and different setup than their home country. Some of the factors may be the difference in teaching and learning approaches. In the KSA, there is gender segregation in teaching institutes. Male & female students’ study in separate schools and institutions. While in Australia, there is coeducation, and emphasis is on open discussions among students, and teachers act as facilitators. Other differences being the mixed gathering and social activities [8]. Non-participation in social activities leads to loneliness among international students, especially those from Muslim cultures [5, 11]. All the religions are being practiced in Australia quite peacefully [12]. The students admitted to various medical universities and teaching institutes are very comfortable with the teaching environment and society’s acceptance [13]. Most Saudi students acquiring postgraduate qualifications are residing with their families, and their children’s exposure to Australian society is encouraging [14, 15]. This study investigated the perceptions of Saudi Arabian medical disciplines students undergoing training in various institutes of Australia regarding psychosocial, cultural, and academic challenges during their stay.

Methods

Study design and setting

This cross-sectional study was conducted from March 15 to June 15, 2019. Ethical approval was taken from the Ethical Review Committee of the University of Faisalabad, Pakistan (Reference No. TUF/Dean/2020/66). The data collection protocol adhered to institutional and national ethical standards, as well as the Helsinki Declaration. Data anonymity and confidentiality are preserved.

The data were collected using the snowball sampling method. Raosoft sample size calculator was used to calculate the representative sample size. The calculated sample size was 208 at a margin of error of 5% with a confidence level of 95%, response rate 50%, and population size 450 (Students’ clubs in Australia confirmed that 450 Saudi students were registered for an undergraduate medical degree, postgraduate and Ph.D. in medical sciences at various institutes during the study period).

Data collection procedure

We invited only those Saudi students registered for an undergraduate medical degree, medical graduates at various institutes in Australia for postgraduation, and Ph.D. in different medical sciences disciplines. We were in touch with the cultural attaché in the Royal Saudi Arabian Embassy, Canberra, to get the contact details of various Saudi Arabian student clubs in different Australian institutes having medical teaching facilities. We received a good response from various student clubs and got the contact number of many medical students. The questionnaire’s link was sent through electronic media (WhatsApp, Facebook messenger, and through emails) & requested those students to help us reach other medical students (snowball technique). Our student co-researchers also helped us to reach many Saudi students and 50 students were directly contacted. Of the total 450, 219 students responded to our questionnaire, so the response rate was 49%. It is less likely that the composition of our respondents was different from the non-respondents because, in our study, there were respondents from both genders, married and unmarried, and all three groups (undergraduate medical degree, medical graduates doing postgraduation, and Ph.D. in different medical sciences disciplines).

Data collection instrument

An online questionnaire was formulated using the LimeSurvey Service to collect the participants’ experiences, observations, and difficulties during their stay in Australia. We gave a brief statement about the research objectives and requested their participation at the start of the questionnaire. The completion of the online questionnaire was considered the students’ consent to participate in the study.

The questionnaire was formulated in English with the help of already published studies [13, 15]. We found that these questions thoroughly evaluate the psychosocial, cultural, and academic challenges Saudi Arabian students face in Australia. Therefore, these questions were used in the present study. The content and construct validity were ensured by two senior professors and a medical educationist proficient in English by evaluating these questions. Moreover, the questionnaire was sent to a few students to check its comprehension and later modified after receiving content experts’ and students’ suggestions. The questionnaire reliability was calculated by Cronbach’s alpha, and its value was 0.93. It consisted of the demographic section with the questions regarding age, gender, site of education in Australia, name of the institution & city, name of the faculty, level of study (undergraduate, postgraduate, or Ph.D.), marital status, accommodation, city of residence in KSA, residing with family or without family, length of stay in Australia, number of visits to KSA since the start of education & overall financial condition. The section on academic satisfaction contained the questions regarding former education, academic performance in Australia, satisfaction regarding various academic activities, including group discussions in mixed gatherings. The psychosocial part was concerned with the knowledge & impression about Australia before their arrival, any experience regarding prejudice treatment in Australia. The questions were also directed to find out adjustments in the Australian way of living and climate, attitudes of fellow Australians, interaction with students of the opposite sex in day-to-day dealing, and group discussions. Moreover, we also explored any difficulty getting temporary jobs during studies, the extent of homesickness, adjustment with the environment, various foods, schooling of children, and others.

We also asked about the children mixing up with Australian friends, family visits to Australian friends’ homes, participation in Australian functions, and traditional get-together. Students’ satisfaction was measured on a five-point Likert scale [16]. If more than 60% of students selected options highly satisfactory and satisfactory or unsatisfactory and highly unsatisfactory, were considered satisfied and unsatisfied, respectively.

Statistical analysis

Collected data was evaluated on SPSS-26. Frequencies and percentages for the different variables were determined [17]. Two-proportion and chi-square testing were conducted to investigate the comparison between the different variables. All the p—values <0.05 have been considered significant.

Results

Two hundred and nineteen students [36(16.4%) females and 183(83.6%) males] participated in this study, and the data were obtained from 42 Australian institutes. The general characteristics of the study participants are shown in Table 1. There were 13 (6.0%) undergraduate, 167(76%) postgraduate, and 39 (18%) Ph.D. students. For most of the students,171(79.2%), Australia was the country of choice for studying. More than two-thirds of students, 154(69.5%), had travelled to KSA one or more than once after arriving in Australia. The majority of the students, 131(59.85%), were financed by the Saudi government, followed by university scholarships, self-financed, and other resources (Table 1).

Table 1

General characteristics of study participants and their choice of study, number of visits to Saudi Arabia, and study financer.

Variables		n	(%)
Gender	Female	36	(16.4)
	Male	183	(83.6)
Age in years	< 30	136	(62.1)
	>30	83	(37.9)
Residing at	Hostel	27	(12.3)
	Self-rented home	179	(81.7)
	Cultural building	13	(5.9)
Marital status	Married	153	(69.9)
	Unmarried	66	(30.1)
Spouse is also a student in Australia	Yes	13	(8.4)
	No	140	(91.6)
If married, number of kids	0	18	(13.0)
	1	39	(25.0)
	2 or more	110	(72.0)
Residing with family	Yes	138	(63.6)
	No	79	(36.4)
Study level	Undergraduate	13	(5.9)
	Postgraduate	167	(76.3)
	PhD	39	(17.8)
Completed course/s in Australia	Bachelor	19	(8.7)
	Master	46	(21.0)
	Other courses	18	(8.2)
	No course completed	136	(62.1)
Australia was the country of choice for studying	Yes	171	(79.2)
	No	45	(20.8)
Number of visits to KSA after arrival in Australia	0	65	(30.5)
	1	61	(28.6)
	2	34	(16.0)
	3	15	(7.0)
	4	19	(8.9)
	> = 5	19	(8.9)
Financer of your Study	Self-financed	21	(9.6)
	Saudi Govt	131	(59.8)
	University scholarship	42	(19.2)
	Other	25	(11.4)

The comparison of satisfaction score by study variables showed that males were more satisfied than females (p = 0.002). Students whose spouses were also studying in Australia were more satisfied than students without spouses (p = 0.004). Other variable differences are given in Table 2.

Table 2

Comparison of satisfaction score by study variables.

Variables		Median (Q1-Q3)	p-value
Gender	Male (n = 183)	3.90 (3.66–4.11)	0.002
	Female (n = 36)	3.78 (3.53–4.03)
Age	<30 (n = 136)	3.78 (3.53–4.03)	0.910
	>30 (n = 83)	3.97 (3.58–4.18)
Residing	Hostel (n = 27)	3.80 (3.34–4.00)	0.433
	Self-rented home (n = 179)	3.90 (3.61–4.10)
	Cultural Building (n = 13)	3.83 (3.57–4.23)
Marital status	Married (n = 153)	3.87 (3.56–4.10)	0.493
	Unmarried (n = 66)	3.87 (3.60–4.11)
Level of study	Undergraduate (13)	3.83 (3.53–4.07)	.207
	Postgraduate (167)	3.83 (3.63–4.03)
	PhD (39)	3.97 (3.57–4.17)
Financer of study	Self-financed (21)	3.93 (3.51–4.34)	.020
	Saudi Govt (131)	3.90 (3.67–4.10)
	University scholarship (42)	3.73 (3.52–3.97)
	Other (25)	3.73 (3.49–4.00)
Residing with family	Yes (138)	3.88 (3.56–4.10)	0.928
	No (79)	3.83 (3.60–4.09)
Spouse is also studying in Australia	Yes (13)	3.90 (3.57–4.13)	0.004
	No (140)	3.83 (3.52–4.03)
Any sign of prejudice you faced	Slight (21) (9.5%)	3.80 (3.47–4.04)	0.003
	No (198) (90.5%)	3.90 (3.63–4.10)

In two-thirds of the students,172(78.6%), Australia’s financial status was highly satisfactory and satisfactory. Most of the students’ impressions, 166 (75.8%), were highly satisfactory and satisfactory about Australia and its people. Four out of five students were highly satisfied and satisfied with their academic performance and studies and adjusted to the Australian way of living. Most of the students, 180(82.2%), were highly satisfied and satisfied with the availability of fair chances of their religious practices and facilities in Australia. A few of the problems Saudi medical disciplines related students faced in Australia were coping with the Australian climate (25[11.4%]), homesickness (59[26.9%]), food and dietary sources (44[20.1%]). Students were overall satisfied with the student advisory system 156(71.2%), university assessments 147(67.2%), available research facilities 170(77.6%), and speaking English at home with family 133(60.7%) (Table 3).

Table 3

Students’ responses to various questions on a five-point scale.

Questions/Statements	Highly satisfactory	Satisfactory	Uncertain	Unsatisfactory	Highly unsatisfactory
	n(%)	n(%)	n(%)	n(%)	n(%)
How is your financial situation here?	38(17.4)	134(61.2)	25(11.4)	17(7.8)	5(2.3)
How well do you feel former education helped you in your study in Australia?	29(13.2)	126(57.5)	32(14.6)	(10.0)	10(4.6)
How much satisfied were you about your knowledge regarding Australia before coming here?	32(14.6)	108(49.3)	49(22.4)	23(10.5)	7(3.2)
How was your impression of Australia and its people when you arrived here?	53(24.2)	113(51.6)	27(12.3)	20(9.1)	6(2.7)
How well are you performing academically?	40(18.3)	133(60.7)	33(15.1)	11(5.0)	2(.9)
Have you got a fair chance to practice your religious routines here?	71(32.4)	109(49.8)	28(12.8)	9(4.1)	2(.9)
How much facilities are available to you for practicing your religion?	44(20.1)	132(60.3)	28(12.8)	12(5.5)	3(1.4)
To what extent you are satisfied with your studies in Australia.	52(23.7)	121(55.3)	21(9.6)	13(5.9)	12(5.5)
To what extent you are satisfied with academic group discussions.	38(17.4)	107(48.9)	40(18.3)	25(11.4)	9(4.1)
To what extent you are satisfied with understanding written English.	50(22.8)	113(51.6)	27(12.3)	22(10.0)	7(3.2)
To what extent you are satisfied with reading Journals, books etc.	46(21.0)	107(48.9)	40(18.3)	19(8.7)	7(3.2)
To what extent you are satisfied with progress in your studies.	50(22.8)	122(55.7)	30(13.7)	11(5.0)	6(2.7)
How do you assess your relationship with your supervisor or teachers?	44(20.1)	115(52.5)	38(17.4)	16(7.3)	6(2.7)
To what extent you are satisfied with adjusting to Australian way of living.	56(25.6)	119(54.3)	25(11.4)	13(5.9)	6(2.7)
To what extent you have coped with Australian climate.	54(24.7)	108(49.3)	32(14.6)	18(8.2)	7(3.2)
To what extent you have coped with problems regarding homesickness.	27(12.3)	95(43.4)	38(17.4)	37(16.9)	22(10.0)
To what extent you are satisfied with food and dietary sources in Australia.	44(20.1)	98(44.7)	33(15.1)	31(14.2)	13(5.9)
How do you feel regarding your day-to-day activities?	36(16.4)	128(58.4)	34(15.5)	15(6.8)	6(2.7)
How satisfied are you with the way Australians treat you?	50(22.8)	119(54.3)	31(14.2)	15(6.8)	4(1.8)
How much satisfied are you in interaction with your fellow Australians?	40(18.3)	111(50.7)	49(22.4)	14(6.4)	5(2.3)
If you have children, are you satisfied with their education here?	42(19.2)	97(44.3)	60(27.4)	13(5.9)	7(3.2)
How satisfied are you with your academic activities?	31(14.2)	130(59.4)	38(17.4)	16(7.3)	4(1.8)
How satisfied are you with the student advisory system?	37(16.9)	119(54.3)	40(18.3)	16(7.3)	7(3.2)
How satisfied are you with University assessments?	31(14.2)	116(53.0)	38(17.4)	24(11.0)	10(4.6)
How satisfied are you with available research facilities?	52(23.7)	118(53.9)	29(13.2)	15(6.8)	5(2.3)
How satisfied are you with the Australian style of clothing?	44(20.1)	105(47.9)	43(19.6)	18(8.2)	9(4.1)
How satisfied are you with your interaction with students of opposite sex?	43(19.6)	118(53.9)	39(17.8)	13(5.9)	6(2.7)
How do you feel about your interaction with opposite-sex students during group discussions?	44(20.1)	118(53.9)	34(15.5)	15(6.8)	8(3.7)
To what extent you are satisfied with speaking English at home with your family.	35(16.0)	98(44.7)	39(17.8)	32(14.6)	15(6.8)

Students’ responses were varied about getting work while studying in Australia; 97(44.3%) stated it was difficult to find, and 87(39.7%) responded they never tried (Fig 1).

Fig 1

Students’ responses regarding getting work while studying in Australia.

Among participants, 77 (35.1%), 119(54.3%), and 23(10.5%) students indicated that they wished to stay in Australia only until completion of their studies, temporarily and permanently, respectively (Fig 2).

Fig 2

Students’ responses regarding staying in Australia after the completion of their studies.

Discussion

The current literature indicates that this is the first study regarding Saudi medical disciplines related students’ experiences in Australia who were registered for an undergraduate medical degree, postgraduate, and Ph.D. in medical sciences at various institutes. A definite cultural difference exists between KSA and Australia. The most challenging experience for Saudi male and female students is the mental adjustment in a different environment [18]. Australian universities are well accustomed to absorbing international students by easing out many difficult adjustment stages. The newly arrived student’s initial challenge is adjusting to a society where language, social culture, and day-to-day dealing differ from one’s parent society. In university life, one is expected to speak out his point of view from the very start of academic activities, and then one finds a diverse society in which expressing oneself in discussion and conversation is essential. [12, 15]. Saudi Arabian students attend English learning classes during summer vacations, so the language barrier gets diluted due to better education standards in local institutions [12].

Two-third of the study participants were married and living in rented accommodations. Most of the study participants were married because most of them were postgraduate students or pursuing a Ph.D. In comparison to our findings, a previous study found that Saudi students were homesick because they couldn’t keep their families with them [19]. Those male Saudi students were undergoing training for ELICOS (English Language Intensive Course for Overseas Students) in an Australian University. Later Saudi Arabian cabinet passed a law that international students could keep their spouses with them during training abroad by special monthly spouse allowance [20]. As per responses recorded by our participants, they were socially active and didn’t feel any hesitation while contacting the opposite-sex students and their families intermixed with Australian friends.

Psychosocial aspects

International students face multiple psychosocial and stress experiences during their stay. They are primarily academic pressures, language difficulties, developing a social relationship with fellow students, and teaching staff [21]. Alsahafi & Shin pointed out that KSA has been among the top ten sources of international students in Australia since 2011 [12]. It has been pointed out that the few significant challenges for Saudi students in the educational environment were open discussions among male and female students and the completion of group assignments with female colleagues [22].

About three out of four of our participants were satisfied with their ability to cope with fellow Australian students and in day-to-day dealing with the locals. Several recent studies have suggested that by visualizing the better living facilities, quite a proportion of international students prefer to settle down in Australia by acquiring citizenship [23, 24]. While among our study participants, only a small proportion (10%) mentioned their wish to stay in Australia permanently after completing their studies.

Cultural aspects

The cultural atmosphere in KSA is religious, so naturally, the Muslim students look for a proper place and atmosphere for religious activities like facilities for prayers during working hours. Australian teaching institutions are supposed to provide a prayer room for their Muslim students [25]. A recent study mentioned that Australia being open, fair, and tolerant of all cultural activities, including all religions, is a favorite place for most international students, including the female students from KSA [26]. The majority of study participants were satisfied with the fair provision of facilities for their religious practices on their campuses and around the residences. A large majority of our study participants (90%) denied any discriminatory practice on the campus or in society. Therefore, most of our participants mentioned their free intermixing with Australian friends and participated in different cultural activities in their vicinity. Australian society is relatively tolerant, and international students don’t face any attitude or discriminatory behavior; moreover, the teaching institutions are very well reputed [27]. This is why most participants mentioned Australia as their first choice for professional training.

Financial aspects

A previous study mentioned that because of lack of finances and cultural restrictions, most male international students couldn’t take their families along with them and be distracted from academic activities [19]. However, that study was published in 2009, and now things have been changed. In our study, the complaints of homesickness were common in unmarried students and those missing the activities of combined family gatherings. Thirty-six students in our study were females, and thirteen out of these 36 went to Australia as spouses of the male students but got admission in undergraduate medicine classes. This clearly shows our participants’ stable financial status and their husbands’ encouraging attitude allowing them to get admitted to medical schools. The majority of Saudi students declared their financial status as satisfactory / highly satisfactory. A study pointed out that financial issues are one of the major causes of disturbance for international students because running & unexpected living charges disturb the students and sometimes, they need to get psychiatric consultations [28]. Australian universities have arranged for part-time jobs for international students to overcome any financial constraints [29]. But our participants’ financial status was stable, so 40% of our participants mentioned that they have never tried for any part-time job. Part-time jobs can be easily obtained in smaller cities & towns compared to big cities [30], and 14% of our study participants pointed out that they got it without difficulty when required a part-time job. Ninety percent of the students committed that they have been financed by the KSA government, different university scholarships, or NGOs. Only a small percentage of the study cohort mentioned that their families are bearing their educational expenses. Most of these students were spouses who decided to get enrolled in undergraduate medical training.

Academic aspects

Several studies have pointed out that learning and mastering English is a key to achieving academic success in any international institute. Most international students faced many problems in classroom discussions, completing the assignments, and various academic activities [18, 31, 32]. Realizing the global demand for the English language in all fields, especially in science, KSA introduced English as a compulsory subject from early school teaching and announced it as the official teaching language in all universities [33]. Saudi students are motivated to take English learning classes during their spare time, such as summer vacations [34, 35]. The preparatory year was introduced in KSA at the start of undergraduate medical training. Students get the English language training and other basic science subjects throughout the year with the concept that they would be grasping the medical subject effectively [30, 36]. Arabic is a powerful language, and almost all Saudi citizens prefer to speak in Arabic. Time would be required for the English language to be the sole language during academic sessions and discussions. Our study cohort included students from various medical disciplines. About 75% of our participants felt very confident in understanding written and verbal English. Most of our participants admitted that KSA’s former education helped them a lot in their studies in Australia. They didn’t complain of any problems during their classroom discussions and completing the group assignments. Overall, four out of five study participants were either satisfied or highly satisfied with their academic performance in their studies and adjusted to the Australian way of life. The majority expressed confidence in university advisory systems for the students, university assessments, and research facilities.

Interestingly, many of the participants mentioned they speak English at home with their families. Among married students, most students had one or more children in Australia. They showed satisfaction regarding their children’s schooling and accepted that they participate in various social activities with Australian families. Most universities keenly socialize their international students to achieve better academic records [18]. Similar to our study, an Australian study explored the Saudi nurses’ experiences of studying in Australia and mentioned that students perceived their learning has a transformative effect on their professional and psychological growth [37].

Implications of the study

KSA is among the top 10 countries sending its youth to world-known institutions for higher education [38]. Most Saudi students prefer the USA, UK, and Canada for postgraduate studies [39]. The present study has highlighted Australia’s conducive and friendly environment where Saudi Muslim students of both genders felt comfortable in a friendly and welcoming society. Our results showed that male and female students expressed satisfaction regarding all aspects of their academic commitments except a few odd experiences, which are part of day-to-day life. We hope the study results would be beneficial not only for students to choose the right destination but also to provide a guideline for the selectors.

Future recommendations

Saudi students going abroad for higher studies are mostly well prepared, as evident from our results. There is always a need for improvement, and we recommend the following measures to be ensured before moving to overseas teaching institutions.

English proficiency must be ensured, and regular sessions must be arranged for mutual discussions in English. Mostly in Saudi schools and colleges, teacher-student interaction is in the native Arabic language. Therefore, we recommend teachers ensure that the discussion medium should be only English during classroom discussions and explanations. Students must be trained for the specific English dialect of the area where they are supposed to land.

Students must be briefed regarding the destination country’s culture, history, and social setup. They should be mentally prepared before landing and don’t feel difficulty mixing up with other students and social gatherings. It is critical for international students to be confident and be able to socialize regarding their academic schedules to fit in the culture of the institutions and society.

Students must develop the habit of book reading as in higher studies, one must complete the assignments quickly and may require lots of studies from various sources to compile the assignment.

Saudi cultural centers in Embassy must be having track & active liaison with their students in various institutions so that the help may be provided in any unforeseen situation.

Limitations of the study

This qualitative study’s findings are based on the data collected from a purposefully selected group of students enrolled at various Australian institutes. The findings may not be generalized as larger mixed studies may be required to access the Saudi students’ experiences in different disciplines across the Australian Universities. Another important limitation was the online nature of the study. Online surveys have several drawbacks, including poor response rate, and it is hard to ascertain whether the right person completed the questionnaire. It’s difficult to contact people who don’t use social media, and frequent requests to finish the survey can be frustrating for participants and often backfire [40]. A subjective self-reported measure and accompanying biases such as acquiescence and dissent biases are also possible.

Conclusions

Our findings showed that Saudi students in Australia had strong psychosocial well-being, cultural integration, and academic success. Most of our students coped up with the difficulties quite successfully. Most of them were satisfied and adjusted well to Australian culture.

18 Mar 2021

PONE-D-21-00081

Psychosocial, cultural and academic challenges to Saudi Arabian International medical students in Australia

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2. Please include additional information regarding the survey or questionnaire used in the study and ensure that you have provided sufficient details that others could replicate the analyses. For instance, if you developed a questionnaire as part of this study and it is not under a copyright more restrictive than CC-BY, please include a copy, in both the original language and English, as Supporting Information.

Additional Academic Editor Comments:

• Why was ethical approval for the present study obtained from the Ethical Review Committee of the University of Faisalabad based in Pakistan while the study was funded by King Abdulaziz University based in Saudi Arabia? The first author is based in Saudi Arabia. Why wasn’t ethical approval obtained from King Abdulaziz University, Saudi Arabia?

• Keywords: Add ‘’medical student’’.

• Introduction-2nd line: Replace ‘’SA” with ‘’Saudi Arabia (SA)”. SA is used as an abbreviation for the first time in the main text here.

• Introduction-1st paragraph-Last line: There is no mention of ‘’Kingdom’’ earlier in the paragraph.

• Introduction-2nd paragraph-1st sentence: Provide a reference to support this statement at the end of the sentence.

• Introduction-2nd paragraph-5th line: Embracing or embarrassing?

• Introduction-2nd paragraph-5th line: How is it embarrassing? Provide details rather than a blanket statement.

• Introduction-2nd paragraph-Last 2 sentences: The ‘’connect……’’ is missing with the rest of the paragraph. Moreover, the last sentence lacks clarity.

• Introduction-3rd paragraph-6th line: Good universities?

• Introduction-Last paragraph-7th line: Mention who are you referring to in relation to ‘’experiences and learnt lessons’’.

• Introduction-Last paragraph-8th line: Delete ‘’was’’.

• Introduction: You have referred to the ‘’Australian culture’’ in the conclusion section of the text. Although the Australian culture is briefly touched upon in the introduction section, strengthen the introduction to the Australian culture in the introduction section.

• Methods: Specify the name of the institution from where the ethical approval was obtained.

• Methods: What do you mean by “Students’ consent was taken, and filling the questionnaire was also considered their consent to participate in the study.”? Was the first consent obtained on-line as well? How was it obtained? This sentence needs to be clarified and accordingly revised. It is not clear regarding how exactly consent was obtained.

• Methods: What do you mean by ‘’religious rights wish to stay further in Australia”?

• Methods: Provide a reference for ‘’five-point Likert scale’’.

• Methods: Provide a reference for ‘’SPSS’’.

• Methods: The methods section requires further work. Reorganize the methods section into relevant categories (example: setting/design, sample/participants, procedure/instruments, analysis, ethical approval). Provide further details as to how the questionnaire was developed. Mention further details regarding when the study was conducted. The title suggests that the participants were medical students (Saudi Arabian medical students studying in Australia), but no mention of medical students in the methods section. How were the participants recruited? How was the sample size calculated? How was the questionnaire distributed online? Provide description of your sample. Two hundred and nineteen (219) Saudi Arabian medical students studying in Australia participated in the present study (1st line of the results section). What was the total number of Saudi Arabian medical students studying in Australia at the time of conducting the survey? What was the response rate? It is important to state the response rate of the survey (219 of how many sent). Questionnaires were sent to how many (potential participants) in total. The percentage of people who responded is an important criterion to judge the statistics. Was there any pattern to those not responding? How likely is it that the composition of all the people to whom the questionnaire was sent, is significantly different from those who responded to the questionnaire?

• Results: Thirty-nine participants (39) were pursuing a PhD. Did you consider even the PhD students as medical students?

• Results-Table 1: What do you mean by ‘’completed course/s in Australia’’? Needs further elaboration.

• Results-Table 1: It would be more interesting to relate the ‘’number of visits to Saudi Arabia after arrival in Australia’’ with the duration of stay in Australia. How many days were spent in Saudi Arabia during these visits?

• Results-Financier of your study: What is the criterion to differentiate ‘’Saudi government’’ from ‘’University scholarship’’? Aren’t most of the universities in Saudi Arabia run by the government. Provide details to avoid further questions and accordingly revise the categories. I would like to know what ‘’others’’ stands for.

• Results-Table 1: Should it be ‘’other degree’’ or ‘’other courses’’ (completed course/s in Australia)?

• Results: What is the age of the participants?

• Discussion-1st sentence: Are you referring to ‘’Saudi Arabian medical students’’?

• Discussion-2nd paragraph-1st sentence: “Early marriage is part of Saudi Arabian culture, so most of our study participants (70%) were married ………. ‘’. You haven’t reported the age of the participants to begin with and therefore how could you provide this reason for most of the study participants being married. It appears to me that most of the participants are married because most of them are postgraduate students or pursuing a PhD; only 13 participants were undergraduate students.

• Discussion-2nd paragraph-Last sentence: Revise ‘’previous study by Midgley W. (2009)’’.

• Discussion-2nd paragraph-Last sentence: Who were the Saudi students in the previous study? Background/course pursuing?

• Discussion-Psychological aspects-1st paragraph: Provide a reference at the end of the 3rd sentence (4th line).

• Discussion-Cultural aspects-2nd line: State the religious activities.

• Discussion-Cultural aspects: Were questions on ‘’halal’’ food included in the questionnaire?

• Discussion-Financial aspects: NGOs is mentioned here. If I am not mistaken, there is no mention of NGOs in the results section.

• Discussion-Limitations of the study: The aim/objective of the study revolved around medical students. Isn’t it? Then why mention that your study related to only medical students. I vehemently do not agree with the related limitations of the study mentioned. Secondly, do not provide a blanket statement that the online nature of the study was a limitation. In what way was the online nature of the study a limitation. What were the limitations that you perceived/faced due to the online nature of the study?

• Discussion: Rewrite the limitations of the study.

• Discussion: Provide a separate paragraph on the implications of the study.

• Discussion: Provide a separate paragraph on recommendations/future directions.

• Conclusions: Draft a better paragraph on the conclusions of the study. Make sure that the conclusions drawn are based on your observations (data) and results while doing so.

- Please note that a recommendation of revision at this stage does not guarantee an acceptance.

- Address (authors’ reply to the comments + revised manuscript) all the reviewers’ comments in addition to the comments made by the Academic Editor.

[Note: HTML markup is below. Please do not edit.]

Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

1. Is the manuscript technically sound, and do the data support the conclusions?

The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented.

Reviewer #1: Yes

Reviewer #2: Yes

**********

2. Has the statistical analysis been performed appropriately and rigorously?

Reviewer #1: Yes

Reviewer #2: Yes

**********

3. Have the authors made all data underlying the findings in their manuscript fully available?

The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified.

Reviewer #1: Yes

Reviewer #2: Yes

**********

4. Is the manuscript presented in an intelligible fashion and written in standard English?

PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here.

Reviewer #1: Yes

Reviewer #2: No

**********

5. Review Comments to the Author

Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters)

Reviewer #1: The research is well-written and focused on medical students with extensive details. The students sample is mainly postgraduate, in which we expect more fluency in English language in addition to more likely financial and social independence. I think this study does not represent undergraduate students.

There are a few grammar conflicts need to be addressed such as:

Page 2: Objectives should not be in the past tense

Page 3: "In the case of interactive lectures, the situation becomes rather embracing" What do you mean by this sentence?

Page 3: "At times, a group of students become a very critic of religious beliefs. It becomes challenging to complete the assignments allotted to students with equal representation of female students where interaction must be quite open and need fluency in English" It is not clear what is the point you are trying to make by these sentences.

Page 3: "good Universities" How could you define good and bad universities?

Page 5: "Religious rights wish to stay further in Australia" There is something missing in this phrase.

Page 7: ". Most of the 166(75.8%)" most of what?

Page 11: "According to a recent, study, " grammar

Reviewer #2: Readable paper, plenty of interesting findings and an under-researched group.

Should have appeal for healthcare researchers and those interested in the Middle East.

The short title needs to have ‘Saudi Arabian’ in it.

It is reasonably understandable on the whole, but I would recommend that a native English speaker review the next draft.

Further comment:

In Table 3, there is a ‘Statement’ column, but they are often phrased as questions. They need to be fixed one way or the other.

P. 10 – ‘There is a lot of’ (cf there are many)

p. 11 ‘Midgley W. (2009) reported Saudi students’ complained of being homesick as they couldn't keep their families with them [20].

So, do you think that the findings in your research could be a function of more family-friendly policies now? Other causes?

P. 12 (55.7%): do not need brackets here. You only need them when you use a number and you want to include the percentage as well: then you put the % in brackets.

P. 13 ‘SA introduced English as a compulsory subject from early school teaching and announced it as official teaching language in all the Universities [33]’. So, is this a change from [when]?

‘Interestingly, 60.7% of participants mentioned they speak English at home with their families’. So, is this a change as well?

These two comments need further interpretation.

Alzahrani (ref 16) does look like a PhD but it calls itself ‘Thesis submitted as a partial fulfilment to obtain the degree of Graduate Certificate in Research Methods’. Also, I cannot see a date on it. Can you clarify?

In the Discussion section, you state:

‘this is the first study regarding Medical students' experiences in Australia’, so you need to say this is the first survey of Saudi Arabian medical students … to differentiate it from, for example, Warren Midgley’s work.

Conclusion

‘Our findings revealed that Saudi medical students' psychosocial wellbeing, cultural adaptation, and academic success in Australia’

There is no main clause in this sentence – needs to be re-written. Furthermore, such a short conclusion does not capture your main findings. The paper should finish showing the ‘take home message’ for the readers.

Stylistic comments

Abbreviations: eg ‘it’s’ cf ‘it has’

Paragraphing: It becomes challenging (new paragraph)

Lack of clarity: ‘faced fewer problems than their (the) senior students’

Word choice: the present study was investigated

rather embracing = ‘overwhelming’?

in their homes (in their home country?)

‘supported these girls to get admitted to medical schools’, cf ‘women’

‘by visualizing the better living facilities’ cf ‘by seeing’?

‘children mixing-up (mixing in) with Australian friends’

Table 2: ‘kids’ (children)

‘so 40% of our participants mentioned that they have never tried for any part-time job. The part-time jobs can be easily obtained in smaller cities & towns compared to big cities [30], and 14% of our study participants pointed out that when they required a part-time job, they got it without difficulty. Less than half of the students got the job when required but with some difficulty’

This is interesting and would benefit from disentangling: so, is is without difficulty or with some difficulty?

Avoiding sexist language

‘to speak out his point of view’, cf ‘their’.

There is still some very cognate research the authors could look at, for example, a paper published in 2012 (Clerehan et al.) in the International Nursing Review on Saudi Arabian nurses' experiences of studying Masters degrees in Australia. The method is different (interviews) and it has a small sample, but the findings have some commonalities (and differences, and I wonder if that is a function of time passing).

Table 1 and 2 appear to overlap.

The two figures do not have captions and it's not clear if they are % or N.

**********

6. PLOS authors have the option to publish the peer review history of their article (what does this mean?). If published, this will include your full peer review and any attached files.

If you choose “no”, your identity will remain anonymous but your review may still be made public.

Do you want your identity to be public for this peer review? For information about this choice, including consent withdrawal, please see our Privacy Policy.

Reviewer #1: No

Reviewer #2: Yes: R Clerehan

[NOTE: If reviewer comments were submitted as an attachment file, they will be attached to this email and accessible via the submission site. Please log into your account, locate the manuscript record, and check for the action link "View Attachments". If this link does not appear, there are no attachment files.]

While revising your submission, please upload your figure files to the Preflight Analysis and Conversion Engine (PACE) digital diagnostic tool, https://pacev2.apexcovantage.com/. PACE helps ensure that figures meet PLOS requirements. To use PACE, you must first register as a user. Registration is free. Then, login and navigate to the UPLOAD tab, where you will find detailed instructions on how to use the tool. If you encounter any issues or have any questions when using PACE, please email PLOS at figures@plos.org. Please note that Supporting Information files do not need this step.

9 May 2021

Editorial comments: We have incorporated all of your suggestions into our revision. They were very helpful. Thank you.

Reviewer 1: We have incorporated all of your suggestions into our revision. They were very helpful. Thank you.

Reviewer 2: We have incorporated all of your suggestions into our revision. They were very helpful. Thank you.

Submitted filename: Response to reviewers Comments.docx

Click here for additional data file.

24 Aug 2021

PONE-D-21-00081R1

Psychosocial, cultural, and academic challenges to Saudi Arabian students in Australia

PLOS ONE

Dear Dr. Jameel,

Thank you for submitting your manuscript to PLOS ONE. After careful consideration, we feel that it has merit but does not fully meet PLOS ONE’s publication criteria as it currently stands. Therefore, we invite you to submit a revised version of the manuscript that addresses the points raised during the review process.

Please submit your revised manuscript by 05-September-2021. When you're ready to submit your revision, log on to https://www.editorialmanager.com/pone/ and select the 'Submissions Needing Revision' folder to locate your manuscript file.

Please include the following items when submitting your revised manuscript:

A 'Response to Reviewers' letter that responds to each point raised by the academic editor and reviewer(s). You should upload this letter as a separate file labeled 'Response to Reviewers'.

A marked-up copy of your manuscript that highlights changes made to the original version. You should upload this as a separate file labeled 'Revised Manuscript with Track Changes'.

An unmarked version of your revised paper without tracked changes. You should upload this as a separate file labeled 'Manuscript'.

If you would like to make changes to your financial disclosure, please include your updated statement in your cover letter. Guidelines for resubmitting your figure files are available below the reviewer comments at the end of this letter.

If applicable, we recommend that you deposit your laboratory protocols in protocols.io to enhance the reproducibility of your results. Protocols.io assigns your protocol its own identifier (DOI) so that it can be cited independently in the future. For instructions see:  http://journals.plos.org/plosone/s/submission-guidelines#loc-laboratory-protocols . Additionally, PLOS ONE offers an option for publishing peer-reviewed Lab Protocol articles, which describe protocols hosted on protocols.io. Read more information on sharing protocols at  https://plos.org/protocols?utm_medium=editorial-email&utm_source=authorletters&utm_campaign=protocols .

We look forward to receiving your revised manuscript.

Kind regards,

Prof. Ritesh G. Menezes, M.B.B.S., M.D., Diplomate N.B.

Academic Editor

PLOS ONE

Journal Requirements:

Please review your reference list to ensure that it is complete and correct. If you have cited papers that have been retracted, please include the rationale for doing so in the manuscript text, or remove these references and replace them with relevant current references. Any changes to the reference list should be mentioned in the rebuttal letter that accompanies your revised manuscript. If you need to cite a retracted article, indicate the article’s retracted status in the References list and also include a citation and full reference for the retraction notice.

[Note: HTML markup is below. Please do not edit.]

Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

1. If the authors have adequately addressed your comments raised in a previous round of review and you feel that this manuscript is now acceptable for publication, you may indicate that here to bypass the “Comments to the Author” section, enter your conflict of interest statement in the “Confidential to Editor” section, and submit your "Accept" recommendation.

Reviewer #1: All comments have been addressed

Reviewer #3: (No Response)

**********

2. Is the manuscript technically sound, and do the data support the conclusions?

The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented.

Reviewer #1: Yes

Reviewer #3: Yes

**********

3. Has the statistical analysis been performed appropriately and rigorously?

Reviewer #1: Yes

Reviewer #3: Yes

**********

4. Have the authors made all data underlying the findings in their manuscript fully available?

The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified.

Reviewer #1: Yes

Reviewer #3: Yes

**********

5. Is the manuscript presented in an intelligible fashion and written in standard English?

PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here.

Reviewer #1: Yes

Reviewer #3: No

**********

6. Review Comments to the Author

Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters)

Reviewer #1: (No Response)

Reviewer #3: In this study, Jamil et al. analyze the psychological, cultural and academic challenges Saudi Arabian students face while studying in Australia. Of the 219 students included in this analysis, we observe majority respondents to be postgraduates, and well-adjusted to the Australian system and culture.

This revised manuscript is significantly better, and authors have done a good job in responding to majority of prior queries. However, I do have a few minor comments:

1) The manuscript could be significantly improved by a copy editor, or having the document proof read as there are a number of stylistic errors in the text.

Abstract:

2) In the results portion of the abstract, I would suggest authors to mention numerical values instead of writing ‘most’ or ‘few’ in lines 3-6 of results. This would help ascertain the actual magnitude of students satisfied with their academic performance and adjustment in Australia.

3) Last four lines of Results in Abstract “Students’ responses regarding responded to a question, "Do you wish to stay in Australia after completion of your studies?", This should be removed to only include the results. Hence authors should instead write “ 77 (35.1%), 119(54.3%), and 23(10.5%) students indicated that they wished to stay in Australia only until completion of their studies, temporarily and permanently, respectively”

Introduction

1) Line 4: “The Ministry of Education of the Kingdom of Saudi Arabia (KSA) sponsored 174333 students for abroad education” This should be written as “The Ministry of Education of the Kingdom of Saudi Arabia (KSA) sponsored 174333 students for education abroad”.

2) As raised earlier, the line “In the the case of interactive lectures, the situation becomes rather embarrassing when it becomes difficult for them to take partparticipate in active discussions and question answer- sessions in classes and ward rounds” does not sit so well with me. It may not be embarrassing, rather difficult to partake in fruitful academic discussions due to language barrier, which may lead to lack of participation. I would suggest the authors to revise this sentence.

3) “International students, especially medical undergraduates, and postgraduates, are among the most successful students in their home countries [6]. This could be because of the better training opportunities and advanced technology available at the universities of the developed countries’ universities.”

This is a bit unclear to me. Do the authors mean developed countries such as Australia or the home country KSA? This should instead be written as international students being successful in their home institutions, who then in search of better training opportunities wish to go abroad. Right now it seems as if the authors are talking about students having better training opportunities in their home country, that’s why they are successful. If this is the case then why would they wish to go abroad? Some clarity would be good to make a strong introduction.

4) “While in Australia teaching is all mixed in Australia”. Suggest to use the word co-education here

Results

1) How many Australian institutes was the data obtained from?

Discussion

1) “The body of the lliterature , indicated” , suggest this to instead write as “current literature indicates”

2) Future recommendations point 1 “Arabic is a very spowerful language, and most of the time, even teacher- student interaction is in the native Arabic language. So, the teachers ensure that , the discussion medium should be only English during classroom discussions and explanations.” Suggest authors to revise this. Difficult to follow the sentence.

**********

7. PLOS authors have the option to publish the peer review history of their article (what does this mean?). If published, this will include your full peer review and any attached files.

If you choose “no”, your identity will remain anonymous but your review may still be made public.

Do you want your identity to be public for this peer review? For information about this choice, including consent withdrawal, please see our Privacy Policy.

Reviewer #1: No

Reviewer #3: No

[NOTE: If reviewer comments were submitted as an attachment file, they will be attached to this email and accessible via the submission site. Please log into your account, locate the manuscript record, and check for the action link "View Attachments". If this link does not appear, there are no attachment files.]

While revising your submission, please upload your figure files to the Preflight Analysis and Conversion Engine (PACE) digital diagnostic tool, https://pacev2.apexcovantage.com/. PACE helps ensure that figures meet PLOS requirements. To use PACE, you must first register as a user. Registration is free. Then, login and navigate to the UPLOAD tab, where you will find detailed instructions on how to use the tool. If you encounter any issues or have any questions when using PACE, please email PLOS at figures@plos.org. Please note that Supporting Information files do not need this step.

20 Sep 2021

PONE-D-21-00081R1

Psychosocial, cultural, and academic challenges to Saudi Arabian students in Australia

PLOS ONE

Journal Requirements:

Please review your reference list to ensure that it is complete and correct. If you have cited papers that have been retracted, please include the rationale for doing so in the manuscript text, or remove these references and replace them with relevant current references. Any changes to the reference list should be mentioned in the rebuttal letter that accompanies your revised manuscript. If you need to cite a retracted article, indicate the article’s retracted status in the References list and also include a citation and full reference for the retraction notice.

Reply:

We have checked the reference list and several references have been corrected. No reference has been removed or added.

Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

1. If the authors have adequately addressed your comments raised in a previous round of review and you feel that this manuscript is now acceptable for publication, you may indicate that here to bypass the "Comments to the Author" section, enter your conflict of interest statement in the “Confidential to Editor” section, and submit your "Accept" recommendation.

Reviewer #1: All comments have been addressed

Reviewer #3: (No Response)

2. Is the manuscript technically sound, and do the data support the conclusions?

The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented.

Reviewer #1: Yes

Reviewer #3: Yes

3. Has the statistical analysis been performed appropriately and rigorously?

Reviewer #1: Yes

Reviewer #3: Yes

4. Have the authors made all data underlying the findings in their manuscript fully available?

The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified.

Reviewer #1: Yes

Reviewer #3: Yes

5. Is the manuscript presented in an intelligible fashion and written in standard English?

PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here.

Reviewer #1: Yes

Reviewer #3: No

6. Review Comments to the Author

Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters)

Reviewer #1: (No Response)

Reviewer #3: In this study, Jamil et al. analyze the psychological, cultural and academic challenges Saudi Arabian students face while studying in Australia. Of the 219 students included in this analysis, we observe majority respondents to be postgraduates, and well-adjusted to the Australian system and culture.

This revised manuscript is significantly better, and authors have done a good job in responding to majority of prior queries. However, I do have a few minor comments:

1) The manuscript could be significantly improved by a copy editor, or having the document proof read as there are a number of stylistic errors in the text.

Reply:

The manuscript has been proofread and several sentences rephrased, and stylistic errors have been removed.

Abstract:

2) In the results portion of the abstract, I would suggest authors to mention numerical values instead of writing 'most' or 'few' in lines 3-6 of results. This would help ascertain the actual magnitude of students satisfied with their academic performance and adjustment in Australia.

Reply:

Thank you for the suggestion. The numerical values have been mentioned as suggested.

3) Last four lines of Results in Abstract "Students' responses regarding responded to a question, "Do you wish to stay in Australia after completion of your studies?", This should be removed to only include the results. Hence authors should instead write “ 77 (35.1%), 119(54.3%), and 23(10.5%) students indicated that they wished to stay in Australia only until completion of their studies, temporarily and permanently, respectively”

Reply:

Thank you for the suggestion. The sentence has been modified as suggested.

Introduction

1) Line 4: "The Ministry of Education of the Kingdom of Saudi Arabia (KSA) sponsored 174333 students for abroad education” This should be written as “The Ministry of Education of the Kingdom of Saudi Arabia (KSA) sponsored 174333 students for education abroad”.

Reply:

Thank you for the suggestion. The sentence has been modified as suggested.

2) As raised earlier, the line “In the case of interactive lectures, the situation becomes rather embarrassing when it becomes difficult for them to take participate in active discussions and question answer- sessions in classes and ward rounds” does not sit so well with me. It may not be embarrassing, rather difficult to partake in fruitful academic discussions due to language barrier, which may lead to lack of participation. I would suggest the authors to revise this sentence.

Reply:

Thank you for the suggestion. The sentence has been modified as suggested.

3) “International students, especially medical undergraduates, and postgraduates, are among the most successful students in their home countries [6]. This could be because of the better training opportunities and advanced technology available at the universities of the developed countries’ universities.”

This is a bit unclear to me. Do the authors mean developed countries such as Australia or the home country KSA? This should instead be written as international students being successful in their home institutions, who then in search of better training opportunities wish to go abroad. Right now it seems as if the authors are talking about students having better training opportunities in their home country, that’s why they are successful. If this is the case then why would they wish to go abroad? Some clarity would be good to make a strong introduction.

Reply:

Thank you for the suggestion. The sentence has been modified as suggested.

4) "While in Australia teaching is all mixed in Australia”. Suggest to use the word co-education here

Reply:

Thank you for the suggestion. The sentence has been modified as suggested.

Results

1) How many Australian institutes was the data obtained from?

Reply:

Data were obtained from 42 Australian institutes (This has been included in the results).

Discussion

1) "The body of the lliterature , indicated” , suggest this to instead write as “current literature indicates”

Reply:

Thank you for the suggestion. The sentence has been modified as suggested.

2) Future recommendations point 1 "Arabic is a very powerful language, and most of the time, even teacher- student interaction is in the native Arabic language. So, the teachers ensure that , the discussion medium should be only English during classroom discussions and explanations.” Suggest authors to revise this. Difficult to follow the sentence.

Reply:

Thank you for the suggestion. The sentence has been modified as suggested.

7. PLOS authors have the option to publish the peer review history of their article (what does this mean?). If published, this will include your full peer review and any attached files.

If you choose "no", your identity will remain anonymous but your review may still be made public.

Do you want your identity to be public for this peer review? For information about this choice, including consent withdrawal, please see our Privacy Policy.

Reviewer #1: No

Reviewer #3: No

Submitted filename: Response to reviewers.docx

Click here for additional data file.

1 Nov 2021

Psychosocial, cultural, and academic challenges to Saudi Arabian students in Australia

PLOS ONE

Dear Dr. Jameel,

Thank you for submitting your manuscript to PLOS ONE. After careful consideration, we feel that it has merit but does not fully meet PLOS ONE’s publication criteria as it currently stands. Therefore, we invite you to submit a revised version of the manuscript that addresses the points raised during the review process.

Please submit your revised manuscript by December 16, 2021. When you're ready to submit your revision, log on to https://www.editorialmanager.com/pone/ and select the 'Submissions Needing Revision' folder to locate your manuscript file.

Please include the following items when submitting your revised manuscript:

A 'Response to Reviewers' letter that responds to each point raised by the academic editor and reviewer(s). You should upload this letter as a separate file labeled 'Response to Reviewers'.

A marked-up copy of your manuscript that highlights changes made to the original version. You should upload this as a separate file labeled 'Revised Manuscript with Track Changes'.

An unmarked version of your revised paper without tracked changes. You should upload this as a separate file labeled 'Manuscript'.

If you would like to make changes to your financial disclosure, please include your updated statement in your cover letter. Guidelines for resubmitting your figure files are available below the reviewer comments at the end of this letter.

11 Dec 2021

PONE-D-21-00081R2

Psychosocial, cultural, and academic challenges to Saudi Arabian students in Australia

Journal Requirements:

Please review your reference list to ensure that it is complete and correct. If you have cited papers that have been retracted, please include the rationale for doing so in the manuscript text, or remove these references and replace them with relevant current references. Any changes to the reference list should be mentioned in the rebuttal letter that accompanies your revised manuscript. If you need to cite a retracted article, indicate the article’s retracted status in the References list and also include a citation and full reference for the retraction notice.

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Reply:

We have removed four references because of duplication. We have avoided including any retracted article.

Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

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Reviewer #3: All comments have been addressed

Reviewer #4: (No Response)

2. Is the manuscript technically sound, and do the data support the conclusions?

The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented.

Reviewer #3: Yes

Reviewer #4: Partly

3. Has the statistical analysis been performed appropriately and rigorously?

Reviewer #3: Yes

Reviewer #4: Yes

4. Have the authors made all data underlying the findings in their manuscript fully available?

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Reviewer #3: Yes

Reviewer #4: Yes

5. Is the manuscript presented in an intelligible fashion and written in standard English?

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Reviewer #3: Yes

Reviewer #4: Yes

6. Review Comments to the Author

Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters)

Reviewer #3: (No Response)

Reviewer #4: I had the opportunity to review the revised manuscript, “Psychosocial, cultural, and academic challenges to Saudi Arabian students in Australia”, for possible publication in the Journal of PLOS ONE. The genesis of the presented study is the fact that studying abroad is associated with psychological, cultural, and academic challenges. In their paper, the authors describe the subjective experience of saudi students of medical related professions in Australia. The authors found that saudi students were overall satisfied with their experience in Australia though this is difficult be generalized to other samples or compared with other results. kindly find my few comments enumerated below.

1- The authors stated that the study was conducted during the year of 2019. The authors may specify the exact timeframe over which the study was conducted, and data were collected as the temporal factors may have a significant effect on participants attitudes.

Reply: It was conducted from March 15 to June 15, 2019. We have incorporated this in the manuscript.

2- Snowball sampling technique was employed to reach out to participants. Could the number of directly contacted participants be specified?

Reply: We contacted 50 students directly. This statement has been included in the methodology of the revised manuscript.

3- “The questionnaire was formulated in English with the help of already published studies”. Could the authors clarify the rationale behind employing this particular questionnaire, and how they insured the validity and the reliability of the questionnaire?

Reply: We found that these questions thoroughly evaluate the psychosocial, cultural, and academic challenges Saudi Arabian students face in Australia. Therefore, these questions were used in the present study. The content and construct validity were ensured by evaluating these questions by two senior professors and a medical educationist proficient in English. Moreover, the questionnaire was sent to a few students to check its comprehension and later modified after receiving content experts’ and students’ suggestions. The questionnaire reliability was calculated by Cronbach’s alpha, and its value was 0.82. We have included the above information in the revised manuscript.

4- Based on the questionnaire responses, how the participants were considered satisfied or not satisfied with their experience? This may be clarified within the methodology section. In other words, when satisfaction was considered as a result?

Reply: Thank you very much for pointing out this. We have incorporated this point in the methodology. "If more than 60% of students selected options highly satisfactory and satisfactory or unsatisfactory and highly unsatisfactory, were considered satisfied and unsatisfied, respectively.”

5- It would be valuable if the Tables and Figures were understandable as stand-alone. I believe that Tables and Figures need more clear descriptive titles.

Reply: Thanks for pointing out this. We have modified the titles of all tables and figures.

6- Unmentioned limitation of this study is the use of subjective self-reported measure and associated biases. For instance, acquiescence bias, where people tend to agree on questionnaire, may skew the result form the truth.

Reply: Thank you for pointing out this. We have mentioned a new sentence in the limitation. “A subjective self-reported measure and accompanying biases such as acquiescence and dissent biases are also possible.”

7- The conclusions need to be supported by the presented data. The first two sentences in the conclusion section cannot be extrapolated from the presented result.

Reply: Thank you for pointing out this. We have removed the first two sentences from the conclusion.

8- The reference list has some duplicate references. Please omit any duplicate.

Reply: Thank you for pointing out this. We are sorry for this mistake. All duplicated references have been removed.

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Reviewer #3: No

Reviewer #4: No

Submitted filename: Response to reveiwers.docx

Click here for additional data file.

30 Dec 2021

Psychosocial, cultural, and academic challenges to Saudi Arabian students in Australia

PONE-D-21-00081R3

Dear Dr. Jameel,

We’re pleased to inform you that your manuscript has been judged scientifically suitable for publication and will be formally accepted for publication once it meets all outstanding technical requirements.

Within one week, you’ll receive an e-mail detailing the required amendments. When these have been addressed, you’ll receive a formal acceptance letter and your manuscript will be scheduled for publication.

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Kind regards,

Prof. Ritesh G. Menezes, M.B.B.S., M.D., Diplomate N.B.

Academic Editor

PLOS ONE

Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

1. If the authors have adequately addressed your comments raised in a previous round of review and you feel that this manuscript is now acceptable for publication, you may indicate that here to bypass the “Comments to the Author” section, enter your conflict of interest statement in the “Confidential to Editor” section, and submit your "Accept" recommendation.

Reviewer #4: All comments have been addressed

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2. Is the manuscript technically sound, and do the data support the conclusions?

The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented.

Reviewer #4: Yes

**********

3. Has the statistical analysis been performed appropriately and rigorously?

Reviewer #4: Yes

**********

4. Have the authors made all data underlying the findings in their manuscript fully available?

The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified.

Reviewer #4: Yes

**********

5. Is the manuscript presented in an intelligible fashion and written in standard English?

PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here.

Reviewer #4: Yes

**********

6. Review Comments to the Author

Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters)

Reviewer #4: (No Response)

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7. PLOS authors have the option to publish the peer review history of their article (what does this mean?). If published, this will include your full peer review and any attached files.

If you choose “no”, your identity will remain anonymous but your review may still be made public.

Do you want your identity to be public for this peer review? For information about this choice, including consent withdrawal, please see our Privacy Policy.

Reviewer #4: No

21 Jan 2022

PONE-D-21-00081R3

Psychosocial, cultural, and academic challenges to Saudi Arabian students in Australia

Dear Dr. Jameel:

I'm pleased to inform you that your manuscript has been deemed suitable for publication in PLOS ONE. Congratulations! Your manuscript is now with our production department.

If your institution or institutions have a press office, please let them know about your upcoming paper now to help maximize its impact. If they'll be preparing press materials, please inform our press team within the next 48 hours. Your manuscript will remain under strict press embargo until 2 pm Eastern Time on the date of publication. For more information please contact onepress@plos.org.

If we can help with anything else, please email us at plosone@plos.org.

Thank you for submitting your work to PLOS ONE and supporting open access.

Kind regards,

PLOS ONE Editorial Office Staff

on behalf of

Prof. Dr. Ritesh G. Menezes

Academic Editor

PLOS ONE