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The Homesickness and Contentment Scale: Developing a Culturally Sensitive Measure of Adjustment for Asians
Heajong Shin and Neil Abell Research on Social Work Practice 1999 9: 45 DOI: 10.1177/104973159900900104 The online version of this article can be found at: http://rsw.sagepub.com/content/9/1/45

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RESEARCH ON SOCIAL WORK PRACTICE

Shin, Abell / HOMESICKNESS AND CONTENTMENT SCALE

The Homesickness and Contentment Scale: Developing a Culturally Sensitive Measure of Adjustment for Asians
Heajong Shin
Soonchunhyang University, South Korea

Neil Abell
Florida State University

This article reports the validity and reliability of the Homesickness and Contentment (HC) scale. The HC scale is a 20-item scale that evolved from a 30-item Homesickness, Loneliness, and Depression scale. The HC scale is intended to be culturally sensitive to an Asian population in measuring emotional and psychological adjustment to a new culture. Unlike other measures of adjustment developed for and tested on Western samples, the HC scale takes into account the private nature of Asians when examining symptoms of homesickness and contentment. Data collected from 201 Chinese and Korean graduate students and spouses in an American university were used for various psychometric tests. Overall, the HC scale showed excellent subscale reliability, high global reliability, high face and factorial validities, and preliminary construct validity. Discussions on validity, reliability, and utility are presented.

Students and their families from other countries have been coming to the United States since 1784 (Hendricks & Skinner, 1977), and the number has increased tremendously since the end of World War II. This increase is due, among many other things, to the importance of the United States as a leading industrial nation and of the English language as the international language. Today, the United States plays a significant role worldwide as a premier provider of higher education for international students. Robinson (1978) noted that Americans are educating those who will be the leaders of the world during the first half of the 21st century. Altbach, Kelley, and Lulat (1985) estimated that the United States spends more than $2.5 billion annually on the
Authors Note: Correspondence may be addressed to Heajong Shin, School of Social Welfare, Soonchunhyang University, San 53-1 Eupnai-ri, Shinchang-myun, Asan-si, Chungman, South Korea, 336-745, or via the Internet at heajong@asan.sch.ac.kr.
Research on Social Work Practice, Vol. 9 No. 1, January 1999 45-60 1999 Sage Publications, Inc.

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education of international students. International students constitute more than 3% of the total enrollment in higher education and 15% of graduate student enrollment. Moreover, recent world economic and political conditions, as well as changes in American policy, have produced an explosion of new immigration (Purcell, 1995). Of the estimated total of more than 55 million people who emigrated to America between 1820 and 1990, more than 10% arrived during the 1980s, mostly from Mexico and Asia, relatively new sources. The resulting stress, fears, and adjustments have produced urgent public concern about these new immigrants (Purcell, 1995). International students encounter many academic and cultural challenges when they come to the United States (Parr, Bradley, & Bingi, 1992). Newly arrived immigrants face similar challenges and difficulties. Homesickness and loneliness are pervasive, and depression is common (Wehrly, 1988). It has been estimated that 15% to 25% of these immigrants have significant adjustment problems (Klineberg & Hull, 1979; Oei & Notowidjojo, 1990). Brislins (1981) study highlighted the effects of culture shock experienced by international studentsirritability, excessive concerns with health, distrust and hostility toward members of the host culture, hopelessness and depression, withdrawal, rigidity, and lowered work performance. Amoh (1984) studied the newly arrived international students at a U.S. university and found that their most common problems are lack of effective communication skills in English, frequency of college examinations at the university, concerns about grades, lack of knowledge about student-faculty relationships in the United States, and comprehending registration procedures. Their social problems are concern about understanding American slang words, concern about being understood by some Americans due to limited vocabulary in English, loneliness, and negative remarks and attitudes from some American students. Personal problems centered on financial difficulties, tension of adjustment to a different environment, locating suitable housing at reasonable cost, and time budgeting in the United States. Newly arrived immigrants experiences are similar to the experience of foreign students. Berry (1990) has described some of changes faced by new immigrants as being physical changes (a new place to live, a new type of housing, increasing population density, urbanization, more pollution, etc.); biological changes (new nutritional status and new diseases); political changes (usually bringing the nondominant groups under some degree of control and usually involving some loss of autonomy); economic changes (moving away from traditional pursuits toward new forms of employment);

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cultural changes (original linguistic, religious, educational, and technical institutions become altered, or imported ones take their place); social relationships (including intergroup and interpersonal relationships and new patterns of dominance); and psychological changes appearing at the individual level. These behavior changes include changes in values, abilities, and motives. Existing identities and attitudes change and new ones develop; self-attitudes often shift away from those held prior to contact, and views about how and whether one should participate in the process of acculturation emerge. Stress phenomena and related pathology both appear during this process. Most research on international students and new immigrants has mainly concentrated on identification of their problems, concerns, and their experiences. There are a few studies that dealt with emotional and psychological well-being of international students (e.g., Befus, 1988; Crittenden, Fugita, Bae, Lamug, & Lin, 1992; Oei & Notowidjojo, 1990). Studies on mental health of new immigrants are more extensive (e.g., Draguns, 1981; Falicov, 1983; Korchin, 1980; Marsella & White, 1984; Purcell, 1995; Sue & Sue, 1995). However, psychometrics used in these studies were standardized scales that were developed by and for people of the host culture. Even though they reported high reliability and validity with the Western population, their use with international populations was not tested. Some of the items on the those scales seemed inappropriate for persons from different cultures. Therefore, there is an urgent need for developing culturally sensitive measures. Development of a culturally sensitive measurement tool involves examination into the nature of the construct itself and its operational definition. In a pilot study with international students from Asian countries, Shin (1992) generated a culturally sensitive measure for homesickness, loneliness, and depression. The 30-item Homesickness, Loneliness, and Depression (HLD) scale was produced in an effort to measure emotional and psychological adjustment of Asian international students to a new culture, because existing standardized scales take no account of special characteristics of the population. Traditional cultural values have a significant impact on the psychological characteristics of this population, particularly those individuals who are recently arrived to the United States (Sue & Sue, 1995). These values strongly support such traits as passivity, deference, reserve, and emotional restraint. It is extremely important to incorporate these traits when psychological and emotional symptoms of adjustment are considered. The HLD scale consists of three subscales that measure homesickness, loneliness, and depression. Symptoms identified to measure the previously discussed concepts were carefully selected to be sensitive to Asian

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populations. The HLD scale has a 5-point Likert-type response set, ranging from 1 (very often) to 5 (never). The overall reliability of the scale is .95 (Cronbachs ). Subscale reliabilities for homesickness, loneliness, and depression are .71, .94, and .96, respectively, based on a sample consisting of international students from Asian countries. The HLD scale had face validity and content validity. Items on the scale were carefully selected based on an extensive literature review on international students and their experiences (Alexander, Klein, Workneh, & Miller, 1981; Altbach et al., 1985; Cadieux & Wehrly, 1986; Crittenden et al., 1992; Kagan & Cohen, 1990). After the initial selection of these items, they were shown to a faculty member and two doctoral-level international students for their feedback on the content. All three agreed that those items represented concepts of homesickness, loneliness, and depression and were appropriate for an Asian population. In this study, reliability and validity of the HLD scale were reexamined with a larger sample, resulting in the simplified and revised Homesickness and Contentment (HC) scale reported herein.

METHOD AND PROCEDURES Sample

Involved in this study were 201 participants. They were located at a public university located in the southeastern region of the United States. The university has about 28,000 students, 786 of whom are international students from all over the world. According to the universitys International Student Center, at the time of this study, there were 129 Chinese students and 66 Korean students enrolled, constituting the two largest groups of international students in the academic year of 1995 to 1996. Of these, 116 Chinese and 54 Korean students were in graduate programs. The study sample was composed of married graduate students and their spouses using a snowball, nonprobability sampling technique. An attempt was made to obtain the lists of people who met the previously noted criteria by contacting the representatives of the student associations of Chinese and Korean students. However, they reported that a complete list was unavailable, leading to the use the snowball approach. Four Chinese interviewers and the writer then contacted married students by telephone and set up a time convenient for them to fill out questionnaires in their own language. The interviewers started with couples in the previous years directories and asked the participants to refer newly arrived couples whom they knew.

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Translation

The questionnaires were translated into Chinese and Korean so that participants who were not fluent in English could participate in this study. The representative of the Chinese Students and Scholars Association, whose members are students from the Peoples Republic of China, was contacted for recommendations for student translators who had fluency both in their native languages and in English and who had experience in survey research. A doctoral student majoring in political science who also worked in a research institute in China was referred and agreed to translate the questionnaire. After the initial translation, copies of the translated questionnaire were distributed to two Chinese graduate students who met the same qualifications as the translator for item-by-item examination. Each reviewer independently performed reverse translations to ensure the accuracy of the instrument. The Korean version was translated by the lead author, who meets the previously noted qualifications. The translated questionnaires were given to two Korean graduate students for item-by-item examination. The same procedure was conducted with the Korean version until all three people agreed on the translations of every instruction and item.
Data Collection

Interviewers delivered the questionnaires to the participants and waited until they completed them. When the participants were answering the selfreport questionnaires, spouses were asked to sit apart from one another so that one would not be influenced by the others presence. It was emphasized that their answers should be based on what they thought as an individual, not as a couple. After they completed the questionnaires, the interviewer collected them. A key holder (worth $10) was given to each household as a token of appreciation.
Data Analysis

The collected data were analyzed for the scales reliability and validity tests using SPSS for Windows (Norusis, 1993). The alpha coefficient method was used for the reliability test, a factorial analysis was used to examine factor structure, and the Pearson product-moment bivariate correlational analysis was used for discriminant and convergent construct validity. A confirmatory factor analysis, rather than exploratory analysis, was used because the purpose was to verify the presence of factors designed as components of each subscale (Abell, McDonnell, & Winters, 1992). The multiple

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group centroid analysis, which places factors through proposed groupings (Nunnally & Bernstein, 1994), was conducted to see if the subscales could be confirmed as distinct factors. This method is also known as oblique multigroup factor analysis and is used with unities on the main diagonal and corrections for part-whole correlations. This method was used to verify that items correlated well with the constructs with which they were supposed to correlate and that they correlated poorly with the constructs with which they were not supposed to correlate (Hudson, 1982). For a subscale to have adequate factorial validity, the factor loadings of the subscales items on that subscale should be of an adequate magnitude (e.g., .30) (Nunnally & Bernstein, 1994). This method was chosen because it is widely used in social work research on measurement validation. The multiple group centroid analysis provides simpler mathematical formulation; therefore, it is easier to interpret and communicate than other confirmatory factor analytic procedures. An effort to determine the discriminant and convergent validities of the HC subscales was made by examining correlations between subscales total score and other factors, such as demographic information and other scale scores. Two scales used in this procedure were the Perception of Coming to the United States (PCTUS) scale (developed for this study) and the Personality and Social Network Adjustment Scale (PSNAS) (Clark, 1968). The PCTUS scale measures the participants perception of coming to the United States. This scale consists of three Likert-type items probing what feelings the participants had when they first came to the United States. Currently, there is no existing instrument that measures perception of this event. This scale was developed for this study and tested for internal consistency with this sample. The PSNAS scale is used to assess broad areas of a participants adjustment in society, in relation to same and opposite gender, and within a family. The PSNAS is a nine-item, 5-point Likert scale instrument that assesses societal, associational, family, and intrapsychic adjustment (Clark, 1968). This scale has been used to assess adjustment of international students in previous studies (e.g., Kagan & Cohen, 1990). The PSNAS had a test-retest reliability of .70 over a period of 4 to 6 weeks with 63 psychiatric inpatients. The scales known-group comparison validity was checked in a comparison between 43 psychiatric patients and a group of university students. The mean score for the students was 7.88 and for the patients 4.39 (p < .01). The scale correlated .56 (p < .01) with the Cornell Index. The PSNAS reliability coefficients calculated in Kagan and Cohens study were similar to those obtained with psychiatric patients. Alphas for the total sample, international students, and American students were .78, .76, and .79, respectively.

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RESULTS Sample Characteristics

For this study, 144 Chinese and 57 Korean students and spouses participated. Of 201 participants, 101 were women and 100 were men. The mean age of the participants was 31 (SD = 3.7) with a range from 24 to 46. Husbands mean age was 32 (SD = 3.8), and wives mean age was 30 (SD = 3.4). Forty percent (n = 80) of the total sample were in doctoral programs; only 15% (n = 29) were in mastersprograms. Another 11% (n = 22) were enrolled in other programs such as undergraduate and postdoctoral programs. Thirtyone percent (n = 62) were not attending any programs, and 4% (n = 8) did not report. Among those who were attending programs, 65% (n = 85) were men and 35% (n = 45) were women. The majority (87%) of nonattending participants were women. On average, the participants had been married for 70 (SD = 38.9) months (range = 4-163), had lived in the United States for 43 (SD = 37.6) months (range = 1-237), and had come to the university 32 (SD = 26.9) months prior to this study (range = 1-120).
Reliability of the HLD Scale

In the previous pilot study, the 30-item HLD scale showed global reliability of .95 (alpha coefficient), and 10-item subscales of homesickness, loneliness, and depression showed alpha coefficients of .71, .94, and .96, respectively. Alpha coefficients with the present sample of 201 students and spouses from Korea and China yielded different results, showing global, homesickness, loneliness, and depression reliabilities to be .85, .85, .73, and .88, respectively. The slight differences yielded in the HLD scale might be due simply to the variability of alpha across samples. In both cases, their magnitudes were acceptable and respectable.
Factorial Validity of the HLD Scale

Multiple group centroid analysis, a confirmatory factor analysis strategy, was used to examine the adequacy of three HLD subscales. Table 1 presents the results of the multiple group centroid analysis. The table presents correlations of the items with subscale scores as computed by a summation of the items in the subscale. Items 1 through 10 belong to the homesickness subscale, Items 11 through 20 comprise the loneliness subscale, and Items 21 through 30 comprise the depression subscale. First, correlation coefficients in the same column were compared to see if any item loading on an

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TABLE 1:

Multiple Group Confirmatory Analysis of the Homesickness, Loneliness, and Depression (HLD) Scale

Subscale
Homesickness

Item
1 2 3 4 5 6 7 8 9 10 11 12b 13 14 15b 16 17 18b 19b 20b 21 22 23 24 25 26b 27b 28b 29b 30b

Homesickness
.79 .62 .73 .43 .49 .52 .57 .77 .83 .84 .02a .05a .44c .15 .12a .17 .07a .01a .18 .33 .02a .06a .37 .06a .12a .10a .19 .06a .24 .14

Loneliness
.09a .14a .15a .50 .18 .01a .15 .21 .03a .18 .41 .66 .09a .59 .71 .29 .49 .68 .77 .65 .25c .44c .39c .34c .43c .51c .55c .69c .57c .61c

Depression
.02a .01a .18a .48 .27 .16a .23 .16 .07a .09a .23 .62c .07a .31 .56c .01a .33 .62c .57c .59c .50 .76 .49 .58 .61 .80 .74 .82 .79 .77

Loneliness

Depression

a. Not significant at p < .05. b. Strong correlation with both loneliness and depression. c. Loading < lowest loading in the other subscale.

unintended subscale was higher than the lowest item loading on the intended subscale. If such items were found, loadings within the same row were compared to see if the item was highly correlated with other subscales. The results were disappointing because one unintended item (loneliness subscale Item 13, I wish I had a friend with whom I could do many things) had a higher correlation on homesickness than one intended homesickness subscale (Item 4,

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TABLE 2:

List of Items on the Contentment Subscale r

Item Number
12 15 18 19 20 26 27 28 29 30

Item

Loneliness
.66 .71 .68 .76 .65 .51 .55 .69 .57 .61

Depression
.62 .56 .62 .57 .59 .80 .74 .82 .79 .77

I feel left alone in this world I feel that nobody understands me I feel lonely I feel that I am not close to anyone I feel excluded by others I feel that my situation is hopeless I am unhappy with myself I feel depressed. I feel overwhelmed and defeated I get upset very easily

I am not happy in the USA), which had the lowest loading within the subscale. Furthermore, the loneliness and depression subscales were not distinguished as separate factors. Rather, items showing high correlation with the depression subscale also showed high correlation with Loneliness. Some examples are as follows: Item 12, I feel left alone in this world (r with loneliness = .66, with depression = .62); Item 30, I get upset easily (r with loneliness = .61, with depression = .77); Item 28, I feel depressed (r with loneliness = .69, with depression = .82); and Item 18, I feel lonely (r with loneliness = .68, with depression = .62).
Development of HC Scale

The preceding analysis suggested a simplified scale structure, leading to a shortened 20-item HC Scale, which is presented in the appendix. The goals were to preserve, as much as possible, the constructs intended in the original HLD measure, and, for future utility, to design a new version of the scale with two 10-item subscales. The homesickness subscale was reconstructed by replacing I am not happy in the USA (r with homesickness = .43, with loneliness = .50, with depression = .48) with I wish I had a friend with whom I could do many things (r with homesickness = .44, with loneliness = .09, with depression = .07). The first item was highly related with all three subscales, and the second item was related only with homesickness. This change was also logically possible because the term friend could mean a person who is already close to the participant, and in many cases that person may be in his or her home country.

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TABLE 3:

Summary of Discriminant and Convergent Validities of the Homesickness and Contentment Scale

Validity
Discriminant

Scale
Homesickness

Variable
SEX MOMARRY PROGRAM Mean SEX MOMARRY PROGRAM Mean MOUSA PCTUS PSNAS Mean MOUSA PCTUS PSNAS Mean

r .01 .11 .04 .05a .00 .11 .05 .06a .25 .16 .18 .20a .14 .11 .27 .17a

r2 .00 .01 .00 .00 .00 .01 .00 .00 .06 .03 .03 .04 .02 .01 .07 .04

Contentment

Convergent

Homesickness

Contentment

NOTE: MOMARRY = number of months married; PROGRAM = academic program in which the participant was enrolled; MOUSA = number of months that the participant stayed in the United States; PCTUS = Perception of Coming to the United States Scale; PSNAS = Personality and Social Network Adjustment Scale. a. This indicates the mean of absolute values.

The second subscale was designed by selecting 10 items that had strong correlations with both the loneliness and depression subscales. These items were selected to represent the two concepts equally. Table 2 shows the item number in HLD, the item, and correlations with loneliness and depression. Content review of the items in the newly composed subscale suggested that the label contentment be used.
Discriminant and Convergent Validity of the HC Scale

The discriminant and convergent validities of the HC subscalesHCH (the homesickness subscale) and HCC (the contentment subscale)were analyzed by examining correlations between subscales total score and other factors. Analysis of discriminant and convergent construct validities is presented in Table 3. Discriminant validity was examined against three demographic variablessex number of months married (MOMARRY), and program in which the participant was enrolledand convergent validity was examined against number of months stayed in United States (MOUSA),

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PCTUS scores, and PSNAS scores. Other demographic variables, such as length of stay at the university and length of stay in the United States, were not selected as discriminant variables because previous studies (Brislin, 1981; Church, 1982; Pruitt, 1978) reported that they were correlated with the adjustment of international students. Discriminant validity was examined through the hypothesis that the three demographic variables would be largely unrelated to homesickness and contentment scores. Analysis of Pearson product-moment correlations showed that there were no significant relations between demographic variables and HCH and HCC scores, as hypothesized. The mean r 2 score of the homesickness and contentment subscales for the discriminant variables was .00. These results indicated that HCH and HCC had discriminant validity. In testing of convergent validities of the HCH and HCC subscales, it was expected that they would have strong correlations with three variables (i.e., MOUSA, PCTUS score, and PSNAS score). Even though the homesickness and contentment subscales are distinct factors, they belong to a larger construct of adjustment. For this reason, their convergent validities were measured against the same variables. Analysis of Pearson productmoment correlations showed that HCH had significant relations with MOUSA, r = .25, p = .00, with PCTUS, r = .16, p = .02, and with PSNAS, r = .18, p = .00. However, MOUSA and PCTUS did not have significant relations with HCC. Although HCH showed significant relations with three convergent indicators, the mean r 2 score of the HCH was .04, indicating a low magnitude of convergent validity. The mean r2 score of HCC for the convergent variables was .04, which also indicated weak evidence of convergent validity.
Reliability of the HC Scale

The global HC scale was computed with all 20 items and showed a mean score of 3.09 (SD = .53). The higher the score, the better adjusted the participant is. A high score in the homesickness subscale reflects a participants low level of homesickness; a high score in the contentment subscale reflects a participants high state of contentment. The homesickness subscale had a mean of 2.52 (SD = .82), and the contentment subscale had a mean of 3.62 (SD = .88). The reliabilities for global scale, the homesickness subscale, and the contentment subscale were .79, .86, and .93, respectively.
Factorial Validity of Homesickness and Contentment Scale

Multiple group centroid analysis with two factors, which is presented in Table 4, showed that the first 10 items that comprise the homesickness

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TABLE 4:

Multiple Group Confirmatory Analysis of the Homesickness and Contentment (HC) Scale

Subscale
Homesickness

Item Number
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20

HCH
.77 .61 .74 .51 .50 .56 .80 .83 .85 .52 .10a .15 .04a .25 .39 .16 .24 .00a .30 .09a

HCC
.12a .17 .29 .28 .03a .18 .31 .06a .23 .12a .76 .73 .72 .72 .77 .78 .83 .84 .86 .74

Contentment

NOTE: HCH = homesickness subscale; HCC = contentment subscale. a. Not significant at p < .05.

subscales were strongly correlated with the HCH subscale (r range = .50-.85) and that the second 10 items that comprise the contentment subscale were strongly correlated with the HCC subscale (r range = .72-.86).

DISCUSSION AND APPLICATIONS TO SOCIAL WORK PRACTICE

The data for this study were gathered from 201 participants at a U.S. southeastern public university. The sample was drawn from international students and their spouses from two Asian countries. This sample cannot be considered representative of international students and their spouses in the United States. Therefore, generalization of results may be restricted. Furthermore, selection of relevant variables for analysis of convergent construct validity was restricted by length of the original data collection package, which included other variables such as family stressors, resources, and coping patterns, as well as inadequately conceived theory.

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Social work has been studying new immigrants since the beginning of the profession. Helping professionals, including social workers, must be aware of unique circumstances and needs of this special population. One of the important qualities required by helping professionals who are working with such a population is cultural sensitivity (Cadieux & Wehrly, 1986). Practitioners who are working with newly arrived immigrants and international students need to be aware of and be sensitive about where each person is in terms of his or her adjustment to the new culture. The HC scale, which was constructed to be culturally sensitive to non-Western populations, can be an effective tool when measuring newly arrived immigrantsand international studentsemotional and psychological adjustment. The HC scale will provide an objective measure of a persons current status of emotional and psychological adjustment. The HC scale can be used in other studies incorporating additional variables. The scale can be used as an outcome measure of the intervention as well as an assessment tool. Other studiessuch as those on the effect of homesickness and contentment on new immigrants and international students marital satisfaction, on international students academic achievement, or on amount of time needed to complete the degreemay use the HC scale to measure the independent variables. Study on factors influencing international students homesickness and contentment may use the HC scale to measure the dependent variables. The HC scale has excellent reliability, high face and factorial validities, and preliminary evidence of construct validity. It is recommended that practitioners use subscales rather than the global score to obtain fuller understanding of their participants. The HC scale is available in English, Chinese, and Korean.1 Translation to other languages such as Japanese and studies on its effectiveness in those languages need to be done to accommodate a larger population not fluent in English. Also, further analysis of construct validity is required, which would incorporate improved convergent indicators. Finally, psychometric studies on homesickness and contentment scales should be conducted with a divergent sample.

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Appendix Homesickness and Contentment Scale


Please read each item carefully and circle the number that best reflects your response,
WHERE: 1 = very often; 2 = often; 3 = sometimes; 4 = rarely; 5 = never.

1. I want to go back to my home country. 1 2 3 2. I write letters to my family and friends back home. 1 2 3

4 4

5 5 5 5 5 5 5 5 5 5 5 5 5 5 5 5 5

3. I am very interested in current situations in my country. 1 2 3 4 4. I remember birthdays of my family back home. 1 2 3 5. I forget my countrys national holidays. 1 2 3 6. I think about what I would do if I were back home. 1 2 3 4 4 4

7. I remember special occasions happening back home. 1 2 3 4 8. I feel homesick. 1 2 3 4 4

9. I miss my friends and family back home. 1 2 3

10. I wish I had a friend with whom I could do many things. 1 2 3 4 11. I feel left alone in this world. 1 2 12. I feel that nobody understands me. 1 2 13. I feel lonely. 1 2 3 3 3 4 4 4 4 4 4 4

14. I feel that I am not close to anyone. 1 2 3 15. I feel excluded by others. 1 2 3

16. I feel that my situation is hopeless. 1 2 3 17. I am unhappy with myself. 1 2 3

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18. I feel depressed. 1

3 3 3

4 4 4

5 5 5

19. I feel overwhelmed and defeated. 1 2 20. I get upset very easily. 1 2

NOTE
1. A copy of the translated scale is available from the first author at no charge.

REFERENCES
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