Food insecurity among postsecondary international students: a scoping review protocol.

INTRODUCTION: International students make significant contributions to their host institutions and countries. Yet research shows that not all international students have the financial means to fend for themselves and meet their financial obligations for the entire study programme. Such students are at significant risk of food insecurity. The objective of this scoping review is to synthesise available information on the factors related to food insecurity among international students studying at postsecondary educational institutions and identify the types of food insecurity interventions that have been implemented to address this issue. METHODS AND ANALYSIS: The Joanna Briggs Institute scoping review methodology will be used to guide this scoping review, and we will search the following databases: MEDLINE (through Ovid), CINAHL (EBSCO), PubMed, ERIC (via Ovid), PROSPERO and ProQuest. The titles, abstracts, and subsequently full texts of the selected papers will then be screened against the inclusion criteria. Data from articles included in the review will be extracted using a data charting form and will be summarised in a tabular form. Thematic analysis will be used to identify common themes that thread through the selected studies and will be guided by the steps developed by Terry et al. ETHICS AND DISSEMINATION: Since this project entails a review of available literature, ethical approval is not required. The findings will be presented at academic conferences and published in a peer-reviewed journal. To make the findings more accessible, they will also be distributed via digital communication platforms. © Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.

The scoping review will map the existing food insecurity interventions for international students at postsecondary institutions across multiple contexts and provide vital insights that may be tailored to different contexts.

Examining the breadth of literature on factors related to food insecurity among international students would improve the understanding of the pertinent issues in this area and allow for the identification of research gaps that should be addressed in the future.

Relevant studies that are not written in English will be omitted, leading to selection bias.

The effectiveness of the food insecurity interventions will not be assessed in the scoping review.

Introduction

As part of a broader effort to compete for highly skilled immigrants and replace an ageing workforce, several advanced economies are focusing on attracting international students, especially those at the postsecondary level.1 Between 2010 and 2017, the share of international students increased by two percentage points across the Organisation for Economic Co-operation and Development (OECD) member countries.2 Many international students choose to study in English-speaking countries in the OECD, particularly Australia, Canada, the UK and the USA. These four countries attract more than 40% of the international students studying in OECD countries.2

International students contribute significantly to their host institutions and countries. In Australia, for instance, international students contributed about US$30.3 billion to the economy in 2017.3 International students in Canada also contributed around US$21.6 billion (via tuition, living expenditures, etc) in 2018 and sustained nearly 170 000 jobs in 2016.4 Furthermore, they increase the pool of qualified employees needed to meet the large medium-term and long-term labour shortages in their host countries.4 Yet many international students experience financial challenges due to costly tuition, fewer funding opportunities, and limited employment opportunities and social networks.5 6

Studying at a university or college in another country can be a demanding and stressful experience, especially in the initial stages.7 8 It requires resilience to adapt to a new learning environment, culture and way of life while juggling academic demands, work and family obligations back home. These challenges may be exacerbated by financial pressure to cover academic and non-academic expenses such as tuition and rent, by exposure to prejudicial or discriminatory treatment, by limited cooking skills or insufficient time to prepare meals, by limited knowledge about the availability of culturally familiar food and by the need to make food choices without family support.6 9 These issues have received extensive examination in the literature because of their potential effect on students' school adjustments, health and food insecurity.10–12

Food insecurity, defined broadly as the unreliable availability, use, stability and access to sufficient, culturally safe and nutritious food, is a widespread global problem with considerable health effects.13–15 As evidence from Canada and other popular immigrant-destination countries continues to accumulate,5 16–20 food insecurity among postsecondary students has been brought to the centre of policy and scholarly discussions. According to a survey on food insecurity among postsecondary students at five Canadian universities, about 39% of students experienced some level of food insecurity.21 A systematic review, involving studies about food insecurity on postsecondary campuses in the USA and other countries, suggests that the rate of food insecurity ranges between 12% and 84%.22 In another review that focused exclusively on college students in the USA, the prevalence rate ranged from 10% to 75%.23 Food insecurity is more common among ethnic minority students because they are more likely to experience structural barriers to getting foods that meet their cultural food needs.18 19 21

Food insecurity severely affects students’ health and academic performance. Several studies have found that food insecurity is associated with poor academic performance.5 24 Food insecure students tend to experience financial strain and thus are more likely to cut back on food expenses to support other living costs21 and to take on survival jobs to supplement their income. Students who must work out of necessity are at risk of being exploited to work illegal hours, in terrible working conditions and often for minimum wage,25 which can harm their health and jeopardise their academic performance. Furthermore, Wright et al’s work19 20 with students at the University of Nevada, Reno, suggests that inadequate availability, access and use of cultural foods, also known as cultural food insecurity, can negatively impact the well-being and identities of international students and students who self-identify as ethnic minorities. Cultural food insecurity reduces an individual’s ability to follow their traditional foodways, which can increase the risk of cultural stress and subsequently lead to anxiety, depression, ethnic isolation and identity erosion.19 26

International students may be particularly vulnerable to the harmful effects of food insecurity because they often live in precarious conditions and have restricted access to rights and entitlements generally associated with permanent residence and citizenship.5 6 For instance, international students in Canada have limited working hours as part of the conditions of their study permit. They can work no more than 20 hours per week off campus during regular school semesters.27 Given that many international students experience financial challenges, having limited working hours increases their vulnerability to poverty and food insecurity. In the USA, international students are not eligible to receive public benefits from federal programmes like the Supplemental Nutrition Assistance Programme, which is primarily restricted to citizens and certain non-citizens who are lawfully present in the country.28

This underscores the urgency to address food security issues among international students. There is extensive research exploring the reasons for increased food insecurity among postsecondary students in general.5 11 The results have informed initiatives like campus food banks, food pantries and other emergency food assistance programmes at various universities and colleges. Yet there are limited studies that synthesise insights from these studies and identify the different initiatives implemented to address food insecurity, especially for international students. Although there are a few scoping reviews on food insecurity among immigrants and students in postsecondary education,17 23 29 these reviews only pay cursory attention to international students' unique issues and experiences because of their broad focus. The proposed scoping review by Shi et al is an exception. However, the primary focus of this review is on postsecondary international students’ dietary changes, their food insecurity status, and factors affecting their nutrition, academic achievement and health outcomes.30

Against this backdrop, a review of studies on the factors that contribute to food insecurity among postsecondary international students and the types of food insecurity interventions designed to assist their food needs in various contexts is warranted, hence the focus of this scoping review. International students face a myriad of challenges that are unique to their situation. As such, food security initiatives and strategies designed for the broader postsecondary student population may not be suitable for them. Indeed, insights gained from this scoping review are required to better understand the unique challenges international students face and identify gaps in the existing literature for future investigations.

This scoping review will focus on studies conducted in Canada, Europe, Australia, New Zealand and the USA since they are popular study places for international students. By reviewing studies conducted in multiple countries, we can acquire a deeper understanding of the issue and its urgency and gain valuable insights into various strategies that can be tailored to unique contexts and circumstances. This review will be guided by two research questions:

What factors have been studied about food insecurity among international students studying at postsecondary educational institutions in Canada, Europe, Australia, New Zealand and the USA?

What types of interventions and strategies for addressing food insecurity among postsecondary international students have been documented?

Methods and analysis

The proposed scoping review will apply the Joanna Briggs Institute (JBI) scoping review methodology,31 which is based on prior work by Arksey and O'Malley32 and Levac et al.33 Below are the steps for conducting a scoping review based on the JBI guidelines.

Inclusion criteria

To be selected in the review, studies must (1) have postsecondary international students as their target population; (2) focus on food insecurity, operationalised as experiencing hunger or issues with the quality or quantity of food consumed, reducing food intake, seeking food assistance, experiencing disrupted eating patterns and having challenges obtaining culturally appropriate foods; (3) be written in English; (4) be performed in popular places for international students to study, including Canada, Europe, Australia, New Zealand and the USA and (5) be a primary research study employing a quantitative, qualitative or mixed-methods research design. In addition to these criteria, we will also include studies that discuss interventions implemented to address food insecurity among international students. The research team will exclude reviews, letters to the editors and opinion pieces from the review.

Search strategy

A limited search of MEDLINE and CINAHL was conducted to find articles on the topic that were used to help construct the full search strategy. A full search strategy was then constructed based on words found from the titles and abstracts of the identified studies, as well as the index terms used to characterise the studies. Online supplemental appendix 1 details the search strategy for MEDLINE. This strategy will be tailored to each database included in the review. To search for additional studies, the reference lists of all included studies will be screened.

Information sources

With the help of a librarian, we will search for relevant literature from the following electronic databases: MEDLINE (via Ovid), CINAHL (EBSCO), PubMed, ERIC (via Ovid), PROSPERO and ProQuest.

Study selection

Following a thorough search of the specified databases, the retrieved results will be compiled and uploaded to Rayyan, a web-tool for screening and selecting studies for knowledge synthesis.34 All duplicate studies will then be detected and deleted. We will follow a two-step screening process. First, the titles and abstracts of the selected papers will be screened independently by two reviewers to ensure they meet the inclusion criteria. Next, the full texts of the papers that make it through the first screening stage will be retrieved and carefully vetted by two reviewers against the inclusion criteria. Any disagreements between the reviewers will be addressed through discussion or with the assistance of a third reviewer who will serve as a tie breaker. The search results and study screening and inclusion procedure will be displayed in a Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews flow diagram. The flow diagram will showcase how many records were identified, screened against the inclusion criteria, and included in the review, along with a rationale for exclusion at each stage.35

Data extraction

After the research studies that will be included in the scoping review have been finalised, two reviewers will independently extract data from the studies using a data charting form developed by the research team. The following details will be extracted: (1) author(s); (2) publication year; (3) country where the research was conducted; (4) aims/objectives of the study; (5) study design; (6) intervention; (7) characteristics of the intervention; (8) key findings and (9) gaps identified. The data charting form will be revised during the data extraction process as reviewers deepen their understanding of the research topic.

Data analysis and presentation

The scoping review will include a table summarising the information collected through the data extraction process. The tabulated results will be accompanied by a narrative summary derived through thematic analysis. Thematic analysis will be performed manually on the extracted data using the steps identified by Terry et al.36 These include the following:

Familiarisation of the data: Once the data extraction has been completed, two researchers will independently read the compilation to gain insight into the data and identify patterns emerging from the initial observation of the data.

Coding: In this step, the researchers will make labels using certain segments of the data that are relevant to the research questions. The coding process will be iterative and flexible, allowing for revisions as the analysis progresses.

Theme development: In this step, the researchers will separately identify the central organising concepts that are shared across a range of codes. They will then independently combine, cluster or collapse the codes they developed into themes and refine them collaboratively.

Reviewing and defining of themes: This is a quality control process in which the researchers will assess the themes to ensure they correspond with the coded data and are relevant to answer the research question.

Defining and naming the themes: This step entails telling a story that is based on the data, allowing the research team to interpret the data in a way that is understandable.

Producing the report: The researchers will compile the findings of the study using the developed themes.

Patient and public involvement

The study is a scoping review, and hence there are no study participants or patients involved.

Discussion

Instances of international students experiencing financial challenges and food insecurity are well documented.5 37 However, their plight may go unnoticed because universities are not required to keep track of international students’ well-being statistics. While several strategies have been implemented to address food insecurity among college students, anecdotal evidence suggests that international students may avoid using these services when needed, partly due to the stigma associated with appearing needy and the fear of being deported for struggling to meet their financial obligations. This implies that strategies for promoting food security among international students might differ from those for the general college student population.

To stimulate further discussions about proactive steps to address the issue, synthesising studies on the factors associated with food insecurity among international students and identifying the various support strategies across multiple countries are required. Yet, little progress has been made in this regard. This scoping review will consolidate insights from available studies, identify gaps in existing literature and provide some much-needed information on how to best support vulnerable international students. Relevant food insecurity interventions will be mapped across multiple contexts, which will yield critical insights that can be customised to different contexts.

There are, however, limitations to this review. Although we will map existing food insecurity interventions across multiple contexts, we will not assess their effectiveness in this scoping review. The review also excludes studies that are not written in English. This could lead to selection bias since we might be leaving out relevant studies on this topic. Without those studies, our descriptive account might not be as comprehensive as it could be.

These limitations notwithstanding, the findings of this scoping review could have far-reaching implications for the scholarly community and postsecondary institutions, as well as immigrant service providers and agencies, student associations and local community organisations. Educational institutions, communities and nations that successfully recruit international students have a moral obligation to maintain their well-being because they contribute significantly to the economy and society. Thus, insights from this review may influence how postsecondary institutions and organisations that assist students collaborate to help vulnerable international students. A discussion about better matrices for measuring international students’ abilities to fully meet their financial obligations for the duration of their studies may also ensue.

Ethics and dissemination

No ethical approval is required since this study is based on the analysis of published literature. Findings will be presented at conferences and published in a peer-reviewed journal. Digital platforms will be used to disseminate the findings.