Are Short-Term Study Abroad Experiences Effective in Developing Global Citizenship in University Students Studying Health Degrees?

Abstract

Short-term study abroad (STSA) experiences are an increasingly popular strategy used by universities to develop global citizenship in students. Global citizenship is particularly important for emerging health professionals with many health challenges of the 21st century being of global importance. Yet, evidence on the effectiveness of STSA is inconclusive, predominantly due to methodological issues limiting research to date. This quasi-experimental study draws on a recognized global citizenship framework encompassing dimensions of social responsibility, global competence, and global civic engagement to examine the changes in global citizenship pre- and post-STSA experience in health students. The sample consisted of health students (n = 75) who participated in an STSA experience (study tour or practicum) from 16 to 22 days in a less industrialized country and a control group (n = 66) who did not partake in any intervention. The data analysis found that students in the intervention group had significant improvements in their overall global citizenship score and its dimensions separately, except for social responsibility, while no significant changes were seen in the control group. The findings provide evidence to support STSA experiences as an accessible option for universities to promote global citizenship development among health students.

1. Introduction

Throughout higher education and employer discourses, global citizenship has become a desired graduate attribute seen as critical for professional and personal success in an increasingly globalized world. Unprecedented events such as the COVID-19 pandemic coupled with deepening global inequalities call for professionals who demonstrate global citizenship competencies—interconnected knowledge, skills, attitudes, expertise, and values. These competencies can be developed through education.

While defining global citizenship is complex, there is consensus on its foundational components [1]. These components are well-documented as a bedrock of global citizenship, despite some variations in interpretations [2,3,4,5]. Morais and Ogden [3] conceptualize and operationalize global citizenship as encompassing three dimensions: (1) social responsibility (emphasizes the sense of interconnectedness, which includes global justice and disparities, altruism and empathy, global interconnectedness, and personal responsibility); (2) global competence (including self-awareness, intercultural communication, and global knowledge); and (3) global civic engagement (encompassing involvement in civic organizations, political voice, and global civic activism).

With respect to global citizenship education (GCE), UNESCO has stated it should be “transformative, building the knowledge, skills, values and attitudes that learners need to be able to contribute to a more inclusive, just and peaceful world” [6] (p.46). UNESCO highlights three core conceptual dimensions of GCE: cognitive, socio-emotional, and behavioral [7]. An important part of GCE is the measurement of learning outcomes consistent with the dimensions and competencies of being a global citizen. In this regard, Morais and Ogden offer a structured multi-dimensional framework, consistent with the UNESCO conception of GCE, that allows the comprehensive measurement of global citizenship through observable behaviors, knowledge, and attitudes. As such, it is a suitable framework for our study, which aims to quantify global citizenship learning outcomes in a systematic manner.

Higher education institutions have a responsibility to provide learning opportunities for students to become global citizens who can contribute to solving global issues [8]. Global citizenship education involving abroad experiences coupled with critical reflection can foster global citizenship development through both transformative and experiential learning experiences [9,10]. Engaging students through these interactive experiences relating to complex issues promotes alternative points of view and allows students to view the world through a different lens [11]. Stoner et al. [12] suggested that in order for the learning experience to be meaningful and shape perspective, students must critically reflect to allow for the opportunity to answer the ‘why’ related to the experience. The connection between theory and participatory efforts then moves beyond disciplinary capabilities and national boundaries to develop mature well-rounded graduates who view the world as interdependent [8].

Developing global citizenship competencies amongst students is particularly emphasized amongst health disciplines, which work directly with the community and require complex intercultural relationships [13]. Health professionals not only deliver culturally sensitive care but also promote and strive for global health equity and equality, thus developing global citizenship in graduates, which may assist this holistic expectation [12]. This process is more important than ever with the increasing burden of non-communicable diseases and the growing disparity between less industrialized and highly industrialized nations [14]. Global citizenship education can provide students with the opportunities to make sense of the inequalities between nations, consolidate theory and reality, gain the required understanding needed to serve a culturally diverse population and address global health challenges [15].

One strategy for facilitating global citizenship development is through study abroad experiences. Traditionally, global study experiences have been offered through semester-long or longer exchange programs; however, short-term study abroad (STSA) experiences have become increasingly popular [16,17,18]. STSA experiences of up to eight weeks have multiple advantages for students and present a pathway for both first-time and future travel [11,17]. These experiences present a realistic and accessible alternative to long-term experiences in terms of economic resources and study requirements [18,19]. They provide an opportunity for many non-traditional and/or resource-constrained students, such as those with family responsibilities, limited economic capital, and/or standing commitments to participate [11,18].

Whilst there is increasing interest surrounding STSA experiences, they have been criticized as being “academically light”, with many higher education institutions as well as government funding prioritizing comparatively longer-term study abroad programs [20]. This is concerning as global citizenship is a desired graduate attribute and according to Tarrant et al. [17], even limited time spent abroad can be beneficial. Current research into long-term study abroad programs has found an association with certain educational outcomes such as the likelihood of volunteering post-study and pursuit of doctoral degrees; however, it does not show a significant difference in areas of intercultural development, personal growth, or academic achievements when compared to shorter experiences [17]. Within the literature, STSA experiences have been found to foster personal relationships and academic performance and lead to improved retention in ethnic minority students [19,21,22]. This notion is furthered by Morais and Ogden [3] who revealed that students who undertook an STSA experience showed elements of global engagement similar to those who had taken longer study experiences.

Previous qualitative and quantitative research has been critical to our understanding of how participation in STSA is linked to the development of global citizenship competencies. However, there are acknowledged methodological limitations including cross-sectional designs, small sample sizes, lack of control groups, and not measuring global citizenship comprehensively [13,23,24,25,26,27,28,29,30,31,32,33,34]. There is great variation in conceptual frameworks and instruments that have been used to measure global citizenship. Finally, some studies have not established baseline measurements, making overall impact difficult to determine [24,25,32,34]. In the emerging literature, these limitations suggest further research is needed to quantify the outcome of experiences across all three dimensions of global competence, social responsibility, and global civic engagement [3]. Given that STSA offers an important developmental opportunity for university students, especially for those undertaking programs with full curricula, it is crucial to improve our understanding of the value and effect of STSA experiences. The current study examines the impact of STSA participation in developing and nurturing global citizenship among university students studying health-related degrees using a quantitative quasi-experimental pre-post intervention study design. A control and intervention group were used to measure overall and subordinate dimensions of global citizenship. As such, this study answers the following research question:

RQ1. 

Does a short-term study abroad experience increase global citizenship among university students studying health degrees?

2. Materials and Methods

2.1. Intervention and Study Participants

The study intervention included two types of short-term study abroad (STSA) experiences: either a study tour or practicum undertaken as a university subject including appropriate assessment (e.g., group research presentations, critical reflections, and professional blogs). Students traveled to less-industrialized countries, including Vietnam, Nepal, Vanuatu, Samoa, Laos, Cambodia, and Peru. The study tours are structured around the following three interrelated components:

• Hear: Classroom workshops around culture and population health delivered by local experts;
• See: Site visits to population health institutions (e.g., Ministry of Health, hospitals, and health centers), NGOs, and community locations;
• Do: Collaborative planning, implementation, and/or evaluation of small-scale population health intervention in a local village (e.g., develop and deliver an education session around hygiene/nutrition/physical activity; educational mural in local primary school).

In contrast, students completing a practicum-style experience engaged in practical work relevant to their degree (e.g., clinical placement at a local primary health care facility) and accumulated practicum hours. Despite these differences, all experiences had a duration of just over two to three weeks (16–22 days overseas) and included activities such as visits to primary, secondary, and tertiary levels of healthcare, government, non-government organizations, education institutions, and the community. Furthermore, both experiences included a three-to-five-day trip to remote, rural, or island communities where students stayed in homestays and completed site visits and community work or practical shifts in local health clinics.

Intervention participants (participating in one of the two types of STSA) included 75 Australian university students studying health-related degrees (e.g., Public Health, Occupational Therapy, Biomedicine, Nutrition, and Dietetics). The control group (no STSA experience) included 66 university students from a range of disciplines, including health.

2.2. Study Design, Data Collection, and Participant Recruitment

This quasi-experimental study used quantitative surveys to collect the data. Data collection was undertaken over a four-year period (2016–early 2020) and included pre- and post-intervention paper-based surveys using the Morais and Ogden [3] global citizenship scale to measure students’ global citizenship. Baseline pre-intervention surveys were administered during face-to-face pre-departure sessions on campus or on the first day of an overseas trip, whilst post-intervention surveys were administered on the final day of the program at the given STSA location. All students participating in the selected STSAs were invited to participate in this study.

The control group consisted of students from various disciplines who completed the survey at both baseline and follow-up, two to three weeks later, using the online survey platform, LimeSurvey. Control group participants were recruited through the University’s broadcast email calling for volunteers for research projects. All participants were provided with participant information and a consent package outlining the purpose of the study and their rights as participants. The submission of a completed survey indicated consent to participate. The study was approved by the Griffith University Human Research Ethics Committee (Ref: 2016/920).

The matched baseline (hereafter pre-intervention) and follow-up surveys were compared to evaluate the impact of STSA on students’ global citizenship across the three dimensions of social responsibility, global competence, and global civic engagement. For each item, participants indicated how much they agreed with the statements relating to each dimension using a 5-point Likert scale. The levels ranged from 1 (strongly disagree) to 5 (strongly agree). The pre-intervention survey also included basic demographic questions on gender, age, country of birth, country of residence, ethnicity, level of study, year of study, name of degree, times traveled overseas, prior STSA experience, volunteer experience, native language and additional languages, hours of paid work per week, family income, and parents’ education. The intervention group had two additional questions: type of STSA experience and days spent overseas. Both surveys took about 10–15 min to complete.

2.3. Data Analysis

Statistical analyses were conducted using SPSS 27. Independent sample t-test tests and Chi-square analyses were used, respectively, for the continuous variables and the dichotomous variables to investigate the potential confounders between the intervention and control groups. Following this, paired t-tests were used to control the identified confounders and determine the impact of STSA on the intervention group compared to the control group regarding the total global citizenship scores and each dimension.

3. Results

3.1. Characteristics of Participants in the Control and Intervention Groups

Amongst STSA experiences, the country most visited by respondents was Vanuatu (n = 18, 24%), followed by Nepal (n = 16, 21.3%), Samoa (n = 15, 20%), Vietnam (n = 12, 16%), and finally, Peru (n = 7, 9.3%), Cambodia (n = 4, 5.3%), and Laos (n = 3, 4%). The majority of students (n = 72, 96%) participated in study tours, whilst (n = 3, 4%) participated in a practicum. The STSA experiences were of a minimum of 16 days and a maximum of 22 days overseas (median 21 days).

Table 1. Participant characteristics (continuous variables).

Characteristic	Intervention Group	Control Group	t-Test	p-Value
Total	75	66
Age			−0.64	0.81
Mean	28.8	29.7
SD	8.3	8.4
Min	21	22
Median	26	26.5
Max	56	56
Times of previous international travel			0.17	0.29
Mean	7.1	6.9
SD	6.7	7.0
Min	0	0
Median	6	4.5
Max	35	30

and

Table 2. Participant characteristics (categorical variables).

Characteristic	Intervention Group		Control Group		Chi-Square Test	p-Value c
	n	%	n	%
Total Gender	75	100.0	66	100.0
Female	65	86.7	52	78.8	1.54	0.21
Male	10	13.3	14	21.2	(d.f. = 1)
Degree Field
Health	75	100.0	28	42.4	59.1	0.00 **
Arts, Education and Law			27	40.9	(d.f. = 1)
Science			2	3.0
Business			9	13.6
Level of study
Undergraduate	62	82.7	47	71.2	2.63	0.11
Postgraduate	13	17.3	19	28.8	(d.f. = 1)
Country of birth
Australia	62	82.7	46	69.7	3.43	0.18
Asia-Pacific a	8	10.7	11	16.7	(d.f. = 2)
Europe	2	2.7	4	6.1
Africa	3	4.0	3	4.5
Other	0	0.0	2	3.0
Native Language
English	72	96.0	55	83.3	6.30	0.01 *
Non-English	3	4.0	11	16.7
Ability to speak another language
Yes	15	20.0	22	33.3	3.23	0.07
No	60	80.0	44	66.7
Family Income
Above well-off	54	72.0	38	57.6	3.22	0.07
Below well-off	21	28.8	28	42.4	(d.f. = 1)
Parents highest level of education
Parent 1
Not Completed High Sch.	19	25.3	17	25.8	1.33	0.72
Completed High School	19	25.3	22	33.3	(d.f. = 3)
University-undergraduate	16	21.3	12	18.2
University-postgraduate	21	28.0	15	22.7
Parent 2
Not Completed High Sch.	25	33.3	20	30.3	0.88	0.93
Completed High School	24	32.0	21	31.8	(d.f. = 4)
University-undergraduate	13	17.3	12	18.2
University-postgraduate	7	9.3	9	13.6
Not applicable b	6	8.0	4	6.1
Have ever studied abroad before
Yes	9	12.0	10	15.2	0.30	0.58
No	66	88.0	56	84.8	(d.f. = 1)

^a Including New Zealand; ^b Including single parent, don’t know, and one missing data from Control group; ^c * p < 0.05, ** p < 0.01.

provide details of the socio-demographic characteristics of participants in both the control and intervention groups. The average age of participants in the intervention and control group was 28.8 and 29.7 years, respectively, and the number of times previously traveled overseas had a median of 7.1 and 6.9 times, respectively. The majority of participants in both groups were female (83%, n = 117). All participants in the intervention group were studying a health-related degree, whereas the control group included 57.6% of students studying a range of other degrees. The majority of participants in both the intervention and control groups were studying at the undergraduate level (77.3%). In both the intervention group and control group, most participants (73.8%) did not speak another language other than English; 90.1% described English as their native language and 76.6% were born in Australia. Some differences were found in family income, with more participants in the intervention group describing their family as well-off (72%) compared to the control group (57.6%); however, these responses were not significant. Parents’ education in both groups was nearly evenly spread between those who had completed tertiary education, high school, or primary school.

Within the intervention group, participants studied a range of health disciplines, with the most common degree being Public Health (n = 19, 25.3%, including Bachelor of Public Health n = 10, 13.3% and Master of Public Health n = 9, 12%), followed by Bachelor of Social Work (n = 16, 21.3%), and Bachelor of Nutrition and Dietetics (n = 7, 9.3%), with smaller numbers drawn from other health degrees.

3.2. Baseline Data Analysis

To determine the comparability of control and intervention groups, a number of statistical tests were undertaken to examine associations between the intervention and control group at baseline. An independent t-test testing for the differences in age and travel experience between the intervention and control group in Table 1 showed no significant differences in age (t = −0.64, p = 0.81) nor times traveled internationally (t = 0.17, p = 0.29). A chi-square test was separately applied to examine the categorical variables, including socio-demographic characteristics and potential confounding factors. In Table 2, the tests showed that there were no significant differences between the intervention and control groups (p > 0.05) in terms of participants’ gender, degree level, country of birth, ability to speak another language, family income, parents’ highest level of education, and previous experience of studying abroad.

The distribution of students’ ‘degree field’ and ‘English as native language’ were significantly different between the two groups (p < 0.05). Therefore, independent t-tests were applied to examine if those two variables were also associated with the overall pre-test global citizenship scores and each dimension of global citizenship. The t-test results indicated that the pre-test scores of global citizenship in the degree field were significantly different. The participants studying in health-related degrees had significantly higher scores than those studying in other degree fields regarding overall Global Citizenship scores (t = 2.57, p = 0.01), Social Responsibility (t = 2.33, p = 0.02), and Global Civic Engagement (t = 2.97, p < 0.01). Also, the independent t-test showed that the pre-test Global Competence scores were significantly lower in the native English speakers than in the other students (t = −3.12, p < 0.01). Both chi-square tests and independent t-tests identified degree field and English as native language as confounders. These variables were distributed differently between the intervention and control groups and were also associated with global citizenship at baseline.

3.3. Post-Intervention Analysis

Paired sample t-tests were used to examine the differences in global citizenship scores between the intervention and control group pre- and post-study. After the STSA program, the intervention group had a very significant increase in Global Citizenship, including Global Competence and Global Civic Engagement (p < 0.001), with the exception of Social Responsibility (t = 1.01, p = 0.31). In contrast, the pre- and post-test global citizenship scores of the control group showed a significant decrease in social responsibility (t = −2.24, p = 0.03) and a marginally significant increase in global civic engagement (t = 2.34, p = 0.02) (See

Table 3. Paired sample t-tests of pre- and post-scores in the intervention and control groups.

	Pre-		Post-		95% C. I.
	Mean	SD	Mean	SD	[Lower, Upper]	t	p
Intervention group (n = 75)
Social Responsibility	4.09	0.37	4.13	0.40	[−0.04, 0.12]	1.01	0.31
Global Competence	3.31	0.42	3.62	0.45	[0.22, 0.41]	6.45	0.00 ***
Global Civic Engagement	3.23	0.49	3.46	0.50	[0.13, 0.34]	4.57	0.00 ***
Overall Global Citizenship	3.51	0.30	3.71	0.32	[0.13, 0.27]	5.85	0.00 ***
Control group (n = 66)
Social Responsibility	3.86	0.50	3.77	0.44	[−0.18, −0.01]	−2.24	0.03 *
Global Competence	3.35	0.52	3.37	0.51	[−0.05, 0.10]	0.64	0.53
Global Civic Engagement	2.73	0.72	2.88	0.68	[0.02, 0.28]	2.34	0.02 *
Overall Global Citizenship	3.26	0.46	3.30	0.39	[−0.03, 0.11]	1.10	0.28

Note. C.I. = Confidence Interval, * p < 0.05, *** p < 0.001.

). However, to confirm these outcomes, we need to exclude the confounding effects.

3.4. Stratification

To deal with the confounding problems in this STSA intervention program, the subsets corresponding to the levels of degree field and English as native language as strata were used in the analysis [35]. Paired t-tests were applied to detect if the increase in the post-test scores of global citizenship was significantly more in the intervention group than in the control group with the stratum-specific state, such as studying either in health-related degrees or in others and native English speakers versus the others.

The paired t-tests in

Table 4. Paired t-tests of pre- and post-scores in the intervention and control groups stratified by the confounders.

		Intervention Group				Control Group
		Pre-	Post-	Difference	p Value	Pre-	Post-	Difference	p Value
		n (M ± SD)	n (M ± SD)	M ± SD		n (M ± SD)	n (M ± SD)	M ± SD
Degree field
Health	Social Responsibility	75 (4.09 ± 0.4)	75 (4.13 ± 0.4)	0.04 ± 0.4	0.31	28 (3.89 ± 0.5)	28 (3.78 ± 0.5)	−0.11 ± 0.4	0.18
	Global Competence	75 (3.31 ± 0.4)	75 (3.62 ± 0.4)	0.31 ± 0.4	0.00 ***	28 (3.35 ± 0.5)	28 (3.28 ± 0.5)	−0.07 ± 0.2	0.13
	Global Civic Engagement	75 (3.23 ± 0.5)	75 (3.46 ± 0.5)	0.24 ± 0.4	0.00 ***	28 (2.72 ± 0.6)	28 (2.82 ± 0.7)	0.10 ± 0.5	0.27
	Overall Global Citizenship	75 (3.51 ± 0.3)	75 (3.71 ± 0.3)	0.20 ± 0.3	0.00 ***	28 (3.26 ± 0.4)	28 (3.25 ± 0.4)	−0.01 ± 0.2	0.77
English as native language
YES	Social Responsibility	72 (4.10 ± 0.4)	72 (4.14 ± 0.4)	0.04 ± 0.4	0.40	55 (3.89 ± 0.5)	55 (3.81 ± 0.4)	−0.08 ± 0.3	0.09
	Global Competence	72 (3.28 ± 0.4)	72 (3.60 ± 0.4)	0.32 ± 0.4	0.00 ***	55 (3.29 ± 0.5)	55 (3.29 ± 0.5)	0.00 ± 0.3	0.97
	Global Civic Engagement	72 (3.23 ± 0.5)	72 (3.44 ± 0.5)	0.21 ± 0.4	0.00 ***	55 (2.67 ± 0.7)	55 (2.81 ± 0.6)	0.14 ± 0.5	0.05
	Overall Global Citizenship	72 (3.51 ± 0.3)	72 (3.70 ± 0.3)	0.19 ± 0.3	0.00 ***	55 (3.22 ± 0.5)	55 (3.26 ± 0.4)	0.03 ± 0.3	0.39
NO	Social Responsibility	3 (3.82 ± 0.2)	3 (4.00 ± 0.2)	0.18 ± 0.3	0.4	11 (3.75 ± 0.5)	11 (3.55 ± 0.5)	−0.2 ± 0.4	0.18
	Global Competence	3 (3.87 ± 0.4)	3 (4.12 ± 0.5)	0.24 ± 0.1	0.3	11 (3.64 ± 0.5)	11 (3.78 ± 0.4)	0.15 ± 0.4	0.23
	Global Civic Engagement	3 (3.08 ± 0.1)	3 (3.99 ± 0.9)	0.91 ± 0.9	0.22	11 (3.02 ± 0.7)	11 (3.21 ± 0.8)	0.2 ± 0.5	0.25
	Overall Global Citizenship	3 (3.54 ± 0.1)	3 (4.03 ± 0.5)	0.49 ± 0.4	0.17	11 (3.42 ± 0.4)	11 (3.49 ± 0.4)	0.06 ± 0.3	0.50

Note. Paired-t-test *** p < 0.001.

showed that short-term study abroad programs improved global citizenship scores after controlling the confounders. In each stratum-specific paired t-test, the overall scores and the scores of dimensions of global competence and global civic engagement were significantly improving in the intervention group (p < 0.001) but not in the control group. The results showed the greatest improvement for the intervention group in the dimension of global competence, followed by global civic engagement; however, there were no significant changes in social responsibility.

4. Discussion

This study set out to understand the effect of short-term study abroad (STSA) experiences on the development of global citizenship in university students studying health-related degrees. Using Morais and Ogden’s [3] global citizenship framework, pre- and post-surveys found that students who participated in STSA experiences significantly improved their overall global citizenship scores, as well as two of three subordinate global citizenship dimensions, namely, global competence and global civic engagement. Confidence in these findings was supported by the inclusion of a control group that showed no change in overall or individual global citizenship dimension scores.

According to the existing literature, socio-demographic characteristics such as gender, level of study, and previous experience with STSA experiences are associated with higher global citizenship scores [36,37,38]. Therefore, a preliminary analysis was undertaken to understand if any distributions of socio-demographic factors variated between the intervention group and the control group to identify the potential confounders. After including the potential confounding socio-demographic variables in the pre-intervention analysis, the initial results found that studying a health-related degree and being a non-native English speaker were associated with higher scores in global citizenship. These findings are consistent with results found by Kayisoglu [39] who revealed increased global citizenship scores in undergraduate physical education students who had foreign language proficiency. Several studies have advocated for the benefits of speaking another language in building intercultural competence and promoting a broader worldview [36,38,40]. Language development within global citizenship education is promoted as a strategy to deepen cultural awareness and empathy by enabling individuals to access diverse perspectives, understand various ways of life, and communicate effectively across cultures [41]. In this study, most participants in both the control and intervention groups did not speak another language and were born in Australia. Given this situation, these results should be interpreted with caution.

It is noteworthy that within the intervention group, a larger proportion of students identified as being from well-off (72%) families compared to the control group (57.6%). However, while the pattern was not significant, it is consistent with the existing literature, which suggests that STSA experiences are often undertaken by wealthier students due to their increased financial security and support [18,42]. Given that STSA experiences are generally more affordable, they offer an opportunity to engage lower-income students who may need to minimize time away from paid work and reduce reliance on personal savings. It is therefore recommended that institutional and government funding initiatives (e.g., New Colombo Plan, Australia [43]) continue to prioritize and expand support for STSA experiences to enhance equity of participation [2].

Whilst there is emerging research suggesting the benefits of STSA experiences in improving global citizenship, questions remain on how STSA programs enable students to obtain the knowledge, skills, and values to achieve this and how to assess the outcomes of global citizen education [1,10,38]. Our study provides some clarity surrounding this, as the intervention delivered followed a structured experience involving hands-on experience with communities as well as a theoretical component that allowed students to think critically and transform traditional patterns of thinking [44]. Of potential interest to practice, when considering curriculum development in the planning of future STYSA experiences, is the importance of aligning theory and practice components (See, Hear, and Do) with the three conceptual dimensions of GCE (7) to maximize impact.

The use of Morais and Ogden’s [3] conceptual framework provided a recognized and replicable measurement of global citizenship outcomes. Analysis of pre- and post-data found that STSA experiences had a statistically significant effect on students’ overall global citizenship scores and that on average, students improved their global citizenship scores by 0.2 points (3.5 to 3.7 out of 5) after participation in a STSA experience. This level of improvement is consistent with a cross-sectional study that compared 201 Turkish Erasmus students undertaking a long-term study abroad experience in Poland with 353 Polish university students who did not partake in any experience [37]. This study used the Morais and Ogden’s global citizenship scale and showed a difference of 0.33 points in global citizenship scores post-experience abroad compared to students who did not undertake an experience (3.34 compared to 2.95 out of 5) [37]. Whilst those who participated in the study abroad experience achieved a notably higher score, this study did not include baseline data and rather, compared two groups. Furthermore, when comparing point differences, it is noted that the Australian students in our study had baseline scores higher than those of Turkish students (3.5 ± 0.3 compared to 3.34 out of 5). To the best of the authors’ knowledge, there are no studies that offer such a comprehensive assessment of STSA experiences, including an overall evaluation of total global citizenship using pre- and post-data along with a comparable control group.

When assessing the subordinate dimensions of global citizenship, it was found that the greatest impact of participating in an STSA experience was on global competence with an average increase of 0.3 (95%, CI 0.2–0.4, p < 0.001). Global competence is described as self-awareness, intercultural communication, and global knowledge [3]. The improvement was measured by scores of 3.3 to 3.6 (out of 5). Intercultural competence, which embodies a similar notion to global competence, is celebrated as a commonly desired graduate attribute due to the need to accept diversity, differing opinions, and power relations and can facilitate entry into the global employment market [10,45,46].

Following global competence, the dimension of global civic engagement had an average increase of 0.24 points (95%, CI 0.1–0.3, p < 0.001). Global civic engagement includes involvement in civic organizations with a political voice and global civic activism [3]. Within tertiary institutions, there is growing awareness surrounding the importance of the civic duties one must fulfill to become an engaged citizen; it is often translated into civic education and curricula [46]. With increasing global challenges, civic competencies must extend beyond national boundaries and engage individuals to think globally in order to understand the interconnectedness and interdependence between countries and populations [47]. With this said, it was promising to find that STSA experiences had an impact on global civic engagement (3.23 to 3.46 out of 5). This finding should be interpreted with some caution as the majority of students completed their post-surveys on the final day of their STSA experience when intentions of engagement may be amplified. This suggests an area for future research using follow-up surveys over different periods of time after the experience to understand sustained impacts.

The final dimension, social responsibility, had not shown significant changes. Nonetheless, it was encouraging to note that this lack of significance was likely due to a relatively high baseline score of 4.1 out of 5. Social responsibility is considered as recognizing global justice and disparities, exhibiting altruism and empathy, and understanding global interconnectedness and personal responsibility. This result suggests that students already had a comprehension of their role and responsibility in society, which may be related to the fact that students were studying health-related degrees. Further research across faculties other than health would be of interest to see if the difference is associated with discipline. Overall, the findings showed a positive improvement in two dimensions of the global citizen conceptual framework and provided compelling support for structured STSA experiences.

Whilst statistically non-significant, it is noteworthy that the intervention groups’ baseline global citizen scores were slightly higher than that of the control groups. This is consistent with reports that suggest that STSA experiences may be more appealing to students who already have global citizenship traits and have a disposition to be more open and willing to further develop their status as global citizens [18,46]. Our study, which looked specifically at students studying health-related degrees, may explain why baseline scores were higher than the control groups, which included students from a range of faculties. Health students are often required to work with diverse communities and provide culturally sensitive care and thus uphold professional identities that have underpinning traits such as concern for others and self-awareness [48,49].

The specific focus and findings relating to health students fill a gap in the global citizenship literature as the limited studies that do explore global citizenship in health students have solely measured the global competence dimension through a proxy measure of cultural competence [13,23,24,25,26,27,28,29,30,31,32,33,34]. Previous research is also limited by methodological features, such as cross-sectional designs, small sample sizes, and a lack of a control group, thus making it difficult to isolate the intervention effect, thereby reducing confidence in the reported findings. The current study is unique in that it includes students studying multiple disciplines within the field of health with previous research predominantly focusing on nursing students. Our study includes two types of STSA experiences and multiple destinations, uses a rigorous design with pre- and post-measurements and a control group, comprises a relatively large sample size, and is based on a recognized conceptual framework.

Limitations

While the study has methodological strengths including robust design, participant numbers, and data collection instruments used, it does have several limitations. Firstly, given the nature of the study, participants could not be randomly allocated to the intervention and control groups. To address this issue, convenience samples of over 65 for both intervention and control groups were drawn, and baseline analysis of socio-demographic factors confirmed that the two groups were mostly comparable except for two variables that were managed during the analysis. Secondly, despite the control and intervention groups matching, the control group comprised university students from a variety of disciplines whereas the intervention group only included health students. While the focus on health students was intentional and a strength of the study, it may also be considered a limitation as it limits the generalizability of the findings. Future research may consider sampling students from a range of academic disciplines and countries to enhance confidence in the generalizability of the findings. Thirdly, a further exploration of differences between study tours and practicums would add value. However, due to the disproportionate number of students participating in study tours (96%) compared to practicums (4%), a quantitative comparison was not feasible in the current study. This limitation highlights an area for future research to investigate these differences more thoroughly with a more balanced sample. Finally, this study included pre- and post-surveys within the time frame of the STSA experience and it is suggested that to understand the sustained impacts of an STSA experience on global citizenship, future research should include a follow-up data collection point 6- or 12-months post-travel. Such a follow-up could be in the form of focus groups or interviews that would offer the opportunity to deepen our understanding of the medium to long-term impact of participation in an STSA experience.

5. Conclusions

This study found that students who participated in an STSA experience significantly improved their overall global citizenship score, as well as in two subordinate dimensions when compared to a control group. The greatest improvement was found in global competence, followed by global civic engagement. A stratification approach was used to isolate the impact of STSA experience. This study offers a significant contribution to the global citizenship literature due to its replicable nature using a relatively large sample size including the use of a comparable control group, specific focus on health disciplines, travel to various less industrialized countries, and examination of total and subordinate domains of global citizenship.

The implications of our findings extend to universities and policymakers as the quantitative evidence can be seen as a basis for educators to discuss the complex phenomena of global citizenship whilst also advocating for the benefits of grants and scholarships. This could contribute to not only changing institutional policy but also promoting equitable access and opportunities for students unable to consider longer study abroad experiences due to personal resource constraints and busy curricula. The most positive findings of STSA experiences on students’ global citizenship levels highlight the value and responsibility universities have in delivering accessible experiences to promote global citizenship development in future students.