title: Should I stay or should I go? A systematic review of factors that influence healthcare students' decisions around study abroad programmes.
abstract: BACKGROUND
  Study abroad programmes have been shown to have significant benefits for participating healthcare students such as promoting cultural awareness and understanding of different healthcare settings, policies and practices. Healthcare students are encouraged to undertake elective or Erasmus placements overseas to enhance personal and professional development and to broaden horizons through lived cultural experience. However, there is a relatively low uptake of such opportunities amongst this student group.
  
  
  OBJECTIVE
  This systematic review aimed to explore factors that influence healthcare students' decision making around study abroad opportunities within undergraduate training programmes.
  A systematic review was undertaken utilising a narrative synthesis approach.
  
  
  METHODS
  A comprehensive literature search was conducted on MEDLINE, CINAHL, EMBASE, PsycINFO, ASSIA, and ERIC databases. Key institutions were contacted for grey literature. Studies that reported on factors that influence healthcare students' decisions regarding study abroad programmes were included in the review.
  
  
  RESULTS
  Ten studies were identified for inclusion (5 qualitative studies, 5 surveys), indicating a paucity of research in this area. Data synthesis indicates that factors that influence healthcare students' decisions to participate in study abroad programmes are similar across different geographic locations and different professional groups. Factors that support decisions to study overseas include having sufficient information about study abroad programmes, especially early in an academic programme, having an interest in other cultures/countries and having academic staff and family as positive role models who motivate them to study abroad. Key barriers are cost and language issues. Language remains a significant barrier even when generous bursaries are available, as with the Erasmus scheme, when students are not proficient with the language spoken in host countries. Students tend to prefer destinations where language is not a problem or where countries have cultural or historical connections, such as being part of the Commonwealth countries.
  
  
  CONCLUSIONS
  Promotion of study abroad opportunities needs to start early in an academic programme. It should include detailed information and provision of language support. Faculty have an important part to play as enthusiastic role models.
authors.affiliation: School of Health Sciences, University of Nottingham, UK. Electronic address: Mary.Brown@nottingham.ac.uk.
authors.forename: Mary
authors.initials: M
authors.lastname: Brown
authors.affiliation: School of Health Sciences, University of Nottingham, UK; Department of Nursing, Kwame Nkrumah University of Science and Technology, Ghana. Electronic address: guardian2405@yahoo.com.
authors.forename: Edward Appiah
authors.initials: EA
authors.lastname: Boateng
authors.affiliation: School of Health Sciences, University of Nottingham, UK. Electronic address: Catrin.Evans@nottingham.ac.uk.
authors.forename: Catrin
authors.initials: C
authors.lastname: Evans
mesh_terms: D004508:Education, Nursing, Baccalaureate; D006801:Humans; D007393:International Educational Exchange / Q000191:economics*; D007802:Language; D009042:Motivation; D015402:Nursing Education Research; D036301:Qualitative Research; D013336:Students, Health Occupations / Q000523:psychology*; D013338:Students, Nursing / Q000523:psychology*
keywords: Elective placement; International placement; Midwifery; Nursing; Physiotherapy; Students; Study abroad; Systematic review and narrative synthesis