He hononga tata ngā āhuatanga pāpori me ngā āhuatanga ōhanga o te hauora (SDOH). He mea nui te whakaaroaro ki te ako i te SDH. Heoi, he torutoru noa ngā pūrongo e tātari ana i ngā kaupapa SDH; ko te nuinga he rangahau whakawhiti-wāhanga. I whai mātou ki te whakahaere i tētahi aromatawai roa o te kaupapa SDH i roto i tētahi akoranga mātauranga hauora hapori (CBME) i whakarewahia i te tau 2018 i runga i te taumata me te ihirangi o te whakaaroaro a ngā ākonga mō te SDH.
Hoahoa rangahau: He huarahi whānui hei whakauru i te tātari raraunga kounga. Kaupapa Mātauranga: He mahi tauira e 4 wiki te roa mō te rongoā whānui me te tiaki tuatahi i te Kura Rongoā o Te Whare Wānanga o Tsukuba, Hapani, e tukuna ana ki ngā ākonga hauora tau rima me te ono. E toru wiki te roa o ngā ākonga e mahi ana i ngā whare hauora hapori me ngā hōhipera i ngā rohe tāone me ngā taiwhenua o te Rohe o Ibaraki. Whai muri i te rā tuatahi o ngā kauhau SDH, i tonoa ngā ākonga ki te whakarite i ngā pūrongo take hanganga i runga i ngā āhuatanga i tūtakihia i te wā o te akoranga. I te rā whakamutunga, i whakapuaki ngā ākonga i ō rātou wheako i roto i ngā hui rōpū, ā, i whakatakoto i tētahi pepa mō te SDH. Kei te whakapai tonu te kaupapa me te whakarato whanaketanga kaiako. Ngā kaiuru o te rangahau: ngā ākonga i whakaoti i te kaupapa i waenga i te Oketopa 2018 me te Pipiri 2021. Tātari: Ko te taumata whakaaroaro ka whakarōpūtia hei whakaaroaro, tātari, whakaahua rānei. Ka tātarihia ngā ihirangi mā te whakamahi i te tūāpapa Solid Facts.
I tātarihia e mātou ngā pūrongo 118 mō te tau 2018-19, ngā pūrongo 101 mō te tau 2019-20, me ngā pūrongo 142 mō te tau 2020-21. E 2 (1.7%), e 6 (5.9%) me te 7 (4.8%) ngā pūrongo whakaaroaro, e 9 (7.6%), e 24 (23.8%) me te 52 (35.9%) ngā pūrongo tātari, e 36 (30.5%) ia, e 48 (47.5%) me te 79 (54.5%) ngā pūrongo whakaahua. Kāore au e kōrero mō te toenga. Ko te maha o ngā kaupapa Solid Facts i roto i te pūrongo he 2.0 ± 1.2, 2.6 ± 1.3, me te 3.3 ± 1.4 ia.
I te whakapai ake i ngā kaupapa SDH i roto i ngā akoranga CBME, ka hohonu haere tonu te māramatanga o ngā ākonga ki te SDH. Tērā pea nā te whanaketanga o ngā kaiako i āwhina i tēnei. Tērā pea me whai whanaketanga kaiako anō mō te māramatanga whakaaroaro ki te SDH, me te whakauru atu ki te mātauranga i roto i ngā pūtaiao pāpori me te rongoā.
Ko ngā mea e whakatau ana i te hauora pāpori (SDH) he mea ehara i te mea hauora e awe ana i te āhua hauora, tae atu ki te taiao e whānau ai, e tipu ai, e mahi ai, e noho ai, e pakeke ai te tangata [1]. He pānga nui tō te SDH ki te hauora o te tangata, ā, kāore e taea e te wawaotanga hauora anake te whakarerekē i ngā pānga hauora o te SDH [1,2,3]. Me mōhio ngā kaiwhakarato hauora ki te SDH [4, 5] me te whai wāhi atu ki te hapori hei kaiwhakatairanga hauora [6] hei whakaiti i ngā pānga kino o te SDH [4,5,6].
E mōhiotia whānuitia ana te hiranga o te whakaako i te SDH i roto i te mātauranga hauora paetahi [4,5,7], engari he maha anō hoki ngā wero e pā ana ki te mātauranga SDH. Mō ngā ākonga hauora, ko te hiranga nui o te hono i te SDH ki ngā ara mate koiora [8] he mōhio ake pea, engari ko te hononga i waenga i te mātauranga SDH me te whakangungu haumanu he iti tonu pea. E ai ki te American Medical Association Alliance for Accelerating Change in Medical Education, he nui ake te mātauranga SDH e whakaratohia ana i ngā tau tuatahi me te tuarua o te mātauranga hauora paetahi i ngā tau tuatoru, tuawhā rānei [7]. Kāore ngā kura hauora katoa i te United States e whakaako ana i te SDH i te taumata haumanu [9], he rerekē ngā roa o ngā akoranga [10], ā, he maha ngā wā he whiringa ngā akoranga [5, 10]. Nā te kore o te whakaae tahi mō ngā pūkenga SDH, he rerekē ngā rautaki aromatawai mō ngā ākonga me ngā kaupapa [9]. Hei whakatairanga i te mātauranga SDH i roto i te mātauranga hauora paetahi, me whakatinana ngā kaupapa SDH i ngā tau whakamutunga o te mātauranga hauora paetahi me te whakahaere aromatawai tika i ngā kaupapa [7, 8]. Kua mōhio anō a Hapani ki te hiranga o te mātauranga SDH i roto i te mātauranga hauora. I te tau 2017, i whakaurua te mātauranga SDH ki roto i te marautanga matua o te mātauranga hauora whakaaturanga, e whakamārama ana i ngā whāinga hei whakatutuki i muri i te whakawhiwhinga i te tohu mātauranga hauora [11]. Ka whakanuia anō tēnei i roto i te whakahoutanga o te tau 2022 [12]. Heoi, kāore anō kia whakatūria ngā tikanga mō te whakaako me te aromatawai i te SDH i Hapani.
I roto i tā mātou rangahau o mua, i aromatawaihia e mātou te taumata o te whakaaroaro i roto i ngā pūrongo a ngā ākonga hauora matua me ā rātou tukanga mā te aromatawai i te aromatawai o te kaupapa SDH i roto i tētahi akoranga mātauranga hauora hapori (CBME) [13] i tētahi whare wānanga Hapanihi. Te Mārama ki te SDH [14]. Ko te mārama ki te SDH me whai akoranga whakarerekē [10]. Ko te rangahau, tae atu ki ā mātou, kua arotahi ki ngā whakaaroaro a ngā ākonga mō te aromatawai i ngā kaupapa SDH [10, 13]. I roto i ngā akoranga tuatahi i tukuna e mātou, te āhua nei i mārama ake ngā ākonga ki ētahi wāhanga o te SDH i ētahi atu, ā, he iti noa iho te taumata o ō rātou whakaaro mō te SDH [13]. I whakahōhonu ake ngā ākonga i tō rātou mārama ki te SDH mā roto i ngā wheako hapori, ā, i hurihia ō rātou tirohanga ki te tauira hauora hei tauira oranga [14]. He mea nui ēnei hua ina kāore anō kia tino whakatūhia ngā paerewa marautanga mō te mātauranga SDH me ā rātou aromatawai me te aromatawai [7]. Heoi, he onge te pūrongo i ngā aromatawai roa o ngā kaupapa SDH paetahi. Mena ka taea e tātou te whakaatu tonu i tētahi tukanga hei whakapai ake me te aromatawai i ngā kaupapa SDH, ka noho hei tauira mō te hoahoa me te aromatawai pai ake o ngā kaupapa SDH, ka āwhina i te whakawhanake i ngā paerewa me ngā whai wāhitanga mō te SDH paetahi.
Ko te whāinga o tēnei rangahau he whakaatu i te tukanga whakapai tonu i te kaupapa mātauranga SDH mō ngā ākonga hauora, me te whakahaere i tētahi aromatawai roa o te kaupapa mātauranga SDH i roto i tētahi akoranga CBME mā te aromatawai i te taumata o te whakaaroaro i roto i ngā pūrongo a ngā ākonga.
I whakamahia e te rangahau he huarahi whānui hei whakauru, ā, i whakahaerehia he tātaritanga kounga o ngā raraunga kaupapa i ia tau mō ngā tau e toru. Ka arotakehia ngā pūrongo SDH o ngā ākonga hauora kua whakaurua ki ngā kaupapa SDH i roto i ngā marautanga CBME. Ko te whakaurunga whānui he tikanga pūnaha mō te tātari i ngā raraunga kounga e taea ai te ārahi i te tātari e ngā whāinga aromatawai motuhake. Ko te whāinga kia puta mai ngā kitenga rangahau mai i ngā kaupapa auau, matua, nui rānei kei roto i ngā raraunga mata, kaua e tautuhia i mua e tētahi huarahi hanganga [15].
Ko ngā kaiuru o te rangahau he tauira hauora tau rima me te tau ono i te Kura Rongoā o Te Whare Wānanga o Tsukuba, ā, i oti i a rātou te mahi tauira haumanu mō ngā wiki e whā i roto i te akoranga CBME i waenga i te marama o Hepetema 2018 me te marama o Mei 2019 (2018–19). Maehe 2020 (2019-20) me Oketopa 2020 me te marama o Hūrae 2021 rānei (2020-21).
He rite te hanganga o te akoranga CBME 4-wiki ki ā mātou rangahau o mua [13, 14]. Ka tango ngā ākonga i te CBME i roto i tō rātou tau tuarima, tuaono rānei, hei wāhanga o te akoranga Whakataki ki te Rongoā, he mea hanga hei whakaako i ngā mātauranga taketake ki ngā tohunga hauora, tae atu ki te whakatairanga hauora, te ngaiotanga, me te mahi tahi a ngā tohunga ngaio. Ko ngā whāinga o te marautanga CBME he whakaatu i ngā ākonga ki ngā wheako o ngā tākuta whānau e whakarato ana i te tiaki tika i roto i ngā momo taiao haumanu; te ripoata i ngā āwangawanga hauora ki ngā tāngata whenua, ki ngā tūroro, me ngā whānau i roto i te pūnaha hauora ā-rohe; me te whakawhanake i ngā pūkenga whakaaro haumanu. . Ia 4 wiki, ka tango te 15-17 ākonga i te akoranga. Ko ngā huringa ko te 1 wiki i roto i te taiao hapori, 1-2 wiki i roto i te whare hauora hapori, i te hōhipera iti rānei, tae atu ki te 1 wiki i roto i te hōhipera hapori, me te 1 wiki i roto i te tari rongoā whānau i te hōhipera whare wānanga. I ngā rā tuatahi me ngā rā whakamutunga, ka huihui ngā ākonga ki te whare wānanga ki te haere ki ngā kauhau me ngā kōrerorero rōpū. I te rā tuatahi, ka whakamārama ngā kaiako i ngā whāinga o te akoranga ki ngā ākonga. Me tuku e ngā ākonga he pūrongo whakamutunga e pā ana ki ngā whāinga o te akoranga. E toru ngā kaiako matua (AT, SO, me JH) e whakamahere ana i te nuinga o ngā akoranga CBME me ngā kaupapa SDH. Ka tukuna te kaupapa e ngā kaiako matua me ngā kaiako tāpiri 10-12 e whai wāhi ana ki te whakaako paetahi i te whare wānanga, me te tuku kaupapa CBME hei rata whānau mahi, hei kaiako hauora kore-taakuta rānei e mōhio ana ki te CBME.
Ko te hanganga o te kaupapa SDH i roto i te akoranga CBME e whai ana i te hanganga o ā mātou rangahau o mua [13, 14] ā, e whakarerekētia tonutia ana (Pikitia 1). I te rā tuatahi, i tae atu ngā ākonga ki tētahi kauhau SDH ā-ringa, ā, i oti i a rātou ngā mahi SDH i roto i te hurihanga 4-wiki. I tonoa ngā ākonga ki te whiriwhiri i tētahi tangata, i tētahi whānau rānei i tūtaki rātou i roto i tā rātou mahi tauira, me te kohikohi i ngā mōhiohio hei whakaaro i ngā āhuatanga ka pā ki tō rātou hauora. Ka whakaratohia e te World Health Organization ngā Solid Facts Second Edition [15], ngā pepa mahi SDH, me ngā tauira pepa mahi kua oti hei rauemi tohutoro. I te rā whakamutunga, i whakaatu ngā ākonga i ā rātou take SDH i roto i ngā rōpū iti, ko ia rōpū he 4-5 ngā ākonga me te 1 kaiako. Whai muri i te whakaaturanga, i tukuna ki ngā ākonga te mahi ki te tuku i tētahi pūrongo whakamutunga mō te akoranga CBME. I tonoa rātou ki te whakaahua me te hono atu ki ō rātou wheako i roto i te hurihanga 4-wiki; i tonoa rātou ki te whakamārama 1) te hiranga o te mārama o ngā tohunga hauora ki te SDH me 2) tā rātou mahi ki te tautoko i te mahi hauora tūmatanui me mahi. I whakawhiwhia ngā ākonga ki ngā tohutohu mō te tuhi i te pūrongo me ngā mōhiohio taipitopito mō te aromatawai i te pūrongo (rauemi tāpiri). Mō ngā aromatawai a ngā ākonga, tata ki te 15 ngā kaiako (tae atu ki ngā kaiako matua) i aromatawai i ngā pūrongo i runga anō i ngā paearu aromatawai.
He tirohanga whānui mō te kaupapa SDH i roto i te marautanga CBME o te Whare Wānanga o Tsukuba Faculty of Medicine i te tau mātauranga 2018-19, me te tukanga whakapai ake i te kaupapa SDH me te whakawhanake i ngā kaiako i ngā tau mātauranga 2019-20 me 2020-21. Ko te 2018-19 e pā ana ki te mahere mai i Oketopa 2018 ki Mei 2019, ko te 2019-20 e pā ana ki te mahere mai i Oketopa 2019 ki Maehe 2020, ā, ko te 2020-21 e pā ana ki te mahere mai i Oketopa 2020 ki Hune 2021. SDH: Ngā Mea Whakatakoto Hauora Hapori, COVID-19: Te Mate Korona 2019
Mai i tōna whakarewatanga i te tau 2018, kua whakarerekē tonu mātou i te kaupapa SDH, ā, kua whakaratohia he whanaketanga kaiako. I te tīmatanga o te kaupapa i te tau 2018, i hoatu e ngā kaiako matua nāna i whakawhanake i ngā kauhau whanaketanga kaiako ki ētahi atu kaiako e whai wāhi ana ki te kaupapa SDH. Ko te kauhau whanaketanga kaiako tuatahi i arotahi ki ngā tirohanga SDH me te pāpori i roto i ngā taiao haumanu.
Whai muri i te otinga o te kaupapa i te tau kura 2018-19, i tū he hui whakawhanake kaiako hei matapaki me te whakaū i ngā whāinga o te kaupapa, me te whakarerekē i te kaupapa kia rite. Mō te kaupapa tau kura 2019-20, i tū mai i te marama o Hepetema 2019 ki te marama o Poutū-te-rangi 2020, i whakaratohia e mātou he Aratohu Kaiāwhina, he Puka Aromatawai, me ngā Paearu mō ngā Kaihautū Kaiako ki te whakahaere i ngā Whakaaturanga Rōpū Kaupapa SDH i te rā whakamutunga. Whai muri i ia whakaaturanga rōpū, i tū he uiui rōpū ki te kaiwhakahaere kaiako hei whakaaroaro mō te kaupapa.
I te tau tuatoru o te kaupapa, mai i te marama o Hepetema 2020 ki te marama o Hune 2021, i tū ngā hui whakawhanake kaiako hei matapaki i ngā whāinga o te kaupapa mātauranga SDH mā te whakamahi i te pūrongo whakamutunga. I hanga e mātou he whakarerekētanga iti ki ngā paearu tuku me te aromatawai pūrongo whakamutunga (rauemi tāpiri). Kua whakarerekētia hoki e mātou te whakatakotoranga me ngā rā kati mō te tuku tono mā te ringaringa me te tuku i mua i te rā whakamutunga ki te tuku tono hiko me te tuku tono i roto i ngā rā e 3 o te keehi.
Hei tautuhi i ngā kaupapa nui me ngā kaupapa noa puta noa i te pūrongo, i arotakehia e mātou te whānuitanga o te whakaata i ngā whakaahuatanga SDH, ā, i tangohia mai ngā āhuatanga pono kua whakahuatia. Nā te mea kua whakaarohia e ngā arotake o mua [10] te whakaaroaro hei momo aromatawai mātauranga me te hōtaka, i whakatauhia e mātou ka taea te whakamahi i te taumata whakaaroaro kua tohua i roto i te aromatawai hei aromatawai i ngā hōtaka SDH. I te mea he rerekē te whakamāramatanga o te whakaaroaro i roto i ngā horopaki rerekē, ka tangohia e mātou te whakamāramatanga o te whakaaroaro i roto i te horopaki o te mātauranga hauora hei "tukanga tātari, pātai me te hanga anō i ngā wheako me te tirohanga ki te aromatawai i aua wheako mō ngā kaupapa ako." "/whakapai ake rānei i te mahi," e ai ki tā Aronson i whakaahua ai, i runga i te whakamāramatanga a Mezirow mō te whakaaroaro arohaehae [16]. Pērā i tā mātou rangahau o mua [13], he wā 4-tau i te 2018–19, 2019–20 me te 2020–21. i roto i te pūrongo whakamutunga, i whakarōpūtia a Zhou hei whakaahua, hei tātari, hei whakaaroaro rānei. Ko tēnei whakarōpūtanga e hangai ana ki te momo tuhituhi mātauranga i whakaahuatia e te Whare Wānanga o Reading [17]. Nā te mea kua aromatawaihia e ētahi rangahau mātauranga te taumata o te whakaaroaro i roto i te huarahi ōrite [18], i whakatau mātou he tika te whakamahi i tēnei whakarōpūtanga hei aromatawai i te taumata o te whakaaroaro i roto i tēnei pūrongo rangahau. Ko te pūrongo kōrero he pūrongo e whakamahi ana i te anga SDH hei whakamārama i tētahi take, engari kāore he whakaurunga o ngā āhuatanga. Ko te pūrongo tātari he pūrongo e whakauru ana i ngā āhuatanga SDH. Whakaaroaro Ko ngā pūrongo ā-ira he pūrongo e whakaaroaro ana ngā kaituhi ki ō rātou whakaaro mō te SDH. Ko ngā pūrongo kāore i taka ki tētahi o ēnei kāwai i whakarōpūtia he kore e taea te aromatawai. I whakamahia e mātou te tātari ihirangi i runga i te pūnaha Solid Facts, putanga 2, hei aromatawai i ngā āhuatanga SDH i whakaahuatia i roto i ngā pūrongo. [19]. He rite tonu ngā ihirangi o te pūrongo whakamutunga ki ngā whāinga o te kaupapa. I tonoa ngā ākonga kia whakaaroaro ki ō rātou wheako hei whakamārama i te hiranga o te mārama o ngā tohunga hauora ki te SDH me ō rātou ake tūranga i roto i te hapori. I tātarihia e SO te taumata whakaata i whakaahuatia i roto i te pūrongo. I muri i te whakaaro ki ngā āhuatanga SDH, i kōrero a SO, JH, me AT, ā, i whakaū i ngā paearu kāwai. I tāruatia anō e SO te tātari. I kōrero anō a SO, JH, me AT mō te tātari o ngā pūrongo e hiahia ana kia whakarerekētia te whakarōpūtanga. I tae rātou ki te whakaae whakamutunga mō te tātari o ngā pūrongo katoa.
I te tau 2018-19, 2019-20 me 2020-21, 118, me 142 ngā ākonga i whai wāhi ki te kaupapa SDH. E 35 (29.7%), 34 (33.7%) me 55 (37.9%) ngā ākonga wahine.
E whakaatu ana te Pikitia 2 i te tohatoha o ngā taumata whakaaroaro i ia tau, i whakaritea ki tā mātou rangahau o mua, i tātari i ngā taumata whakaaroaro i roto i ngā pūrongo i tuhia e ngā ākonga i te tau 2018-19 [13]. I te tau 2018-2019, 36 (30.5%) ngā pūrongo i whakarōpūtia hei kōrero pakiwaitara, i te tau 2019-2020 – 48 (47.5%) ngā pūrongo, i te tau 2020-2021 – 79 (54.5%) ngā pūrongo. E 9 (7.6%) ngā pūrongo tātari i te tau 2018-19, 24 (23.8%) ngā pūrongo tātari i te tau 2019-20 me te 52 (35.9%) i te tau 2020-21. E 2 (1.7%) ngā pūrongo whakaaroaro i te tau 2018-19, 6 (5.9%) i te tau 2019-20 me te 7 (4.8%) i te tau 2020-21. E 71 (60.2%) ngā pūrongo i whakarōpūtia hei kore e taea te arotake i te tau 2018-2019, e 23 (22.8%) ngā pūrongo i te tau 2019-2020, ā, e 7 (4.8%) ngā pūrongo i te tau 2020–2021. I whakarōpūtia hei kore e taea te aromatawai. Kei te Ripanga 1 ngā tauira pūrongo mō ia taumata whakaaroaro.
Te taumata o te whakaaroaro i roto i ngā pūrongo a ngā ākonga mō ngā kaupapa SDH i tukuna i ngā tau mātauranga 2018-19, 2019-20 me 2020-21. Ko te 2018-19 e pā ana ki te mahere mai i Oketopa 2018 ki Mei 2019, ko te 2019-20 e pā ana ki te mahere mai i Oketopa 2019 ki Poutū-te-rangi 2020, ā, ko te 2020-21 e pā ana ki te mahere mai i Oketopa 2020 ki Pipiri 2021. SDH: Ngā Mea Whakatakoto Hapori mō te Hauora
Ko te ōrau o ngā āhuatanga SDH i whakaahuatia i roto i te pūrongo e whakaaturia ana i te Pikitia 3. Ko te toharite o ngā āhuatanga i whakaahuatia i roto i ngā pūrongo he 2.0 ± 1.2 i te tau 2018-19, 2.6 ± 1.3 i te tau 2019-20, me te 3.3 ± 1.4 i te tau 2020-21.
Te ōrau o ngā ākonga i kōrero mō ia āhuatanga i roto i te Anga Whakamārama Tūturu (Putanga Tuarua) i roto i ngā pūrongo 2018-19, 2019-20, me 2020-21. Ko te wā 2018-19 e pā ana ki Oketopa 2018 ki Mei 2019, ko te 2019-20 e pā ana ki Oketopa 2019 ki Poutū-te-rangi 2020, ā, ko te 2020-21 e pā ana ki Oketopa 2020 ki Hune 2021, koinei ngā rā o te kaupapa. I te tau mātauranga 2018/19 he 118 ngā ākonga, i te tau mātauranga 2019/20 – 101 ngā ākonga, i te tau mātauranga 2020/21 – 142 ngā ākonga.
I whakaurua e mātou he kaupapa mātauranga SDH ki roto i tētahi akoranga CBME e hiahiatia ana mō ngā ākonga hauora paetahi, ā, i whakaaturia ngā hua o tētahi aromatawai e toru tau te roa o te kaupapa e aromatawai ana i te taumata o te whakaata SDH i roto i ngā pūrongo a ngā ākonga. I muri i te 3 tau o te whakatinanatanga o te kaupapa me te whakapai tonu, i taea e te nuinga o ngā ākonga te whakaahua i te SDH me te whakamārama i ētahi o ngā āhuatanga o te SDH i roto i tētahi pūrongo. I tētahi atu taha, he torutoru noa iho ngā ākonga i kaha ki te tuhi pūrongo whakaaroaro mō te SDH.
Ki te whakatauritea ki te tau kura 2018-19, i kitea i ngā tau kura 2019-20 me 2020-21 te pikinga haere o te ōwehenga o ngā pūrongo tātari me ngā pūrongo whakaahua, engari i heke nui te ōwehenga o ngā pūrongo kāore i aromatawaitia, nā te whakapainga pea o te kaupapa me te whanaketanga kaiako. He mea nui te whanaketanga kaiako ki ngā kaupapa mātauranga SDH [4, 9]. Ka whakaratohia e mātou he whanaketanga ngaio tonu mō ngā kaiako e whai wāhi ana ki te kaupapa. I te whakarewatanga o te kaupapa i te tau 2018, kua whakaputa noa te Japan Primary Care Association, tētahi o ngā whakahaere rongoā whānau mātauranga me te hauora tūmatanui o Hapani, i tētahi kōrero mō te SDH mō ngā tākuta tiaki tuatahi Hapanihi. Ko te nuinga o ngā kaiwhakaako kāore i te mōhio ki te kupu SDH. Mā te whai wāhi ki ngā kaupapa me te taunekeneke ki ngā ākonga mā roto i ngā whakaaturanga take, ka āta whakahōhonu ake ngā kaiako i tō rātou māramatanga ki te SDH. Hei tāpiri, mā te whakamārama i ngā whāinga o ngā kaupapa SDH mā roto i te whanaketanga ngaio kaiako tonu ka āwhina pea ki te whakapai ake i ngā tohu mātauranga kaiako. Ko tētahi whakapae pea ko te whakapainga o te kaupapa i roto i te wā. Ko aua whakapainga kua whakaritea ka nui te wā me te kaha e hiahiatia ana. Mō te mahere 2020–2021, ko te pānga o te mate urutā COVID-19 ki te oranga me te mātauranga o ngā ākonga [20, 21, 22, 23] ka meinga pea ngā ākonga kia kite i te SDH hei take e pā ana ki ō rātou ake oranga, ā, ka āwhina i a rātou ki te whakaaro mō te SDH.
Ahakoa kua piki ake te maha o ngā āhuatanga SDH i whakahuatia i roto i te pūrongo, he rerekē te auau o ngā āhuatanga rerekē, e pā ana pea ki ngā āhuatanga o te taiao mahi. Kāore i te miharo te nui o ngā reiti tautoko pāpori i te mea he maha ngā whakapā atu ki ngā tūroro kua whiwhi tiaki hauora. I whakahuatia pinepinetia hoki te kawe waka, nā te mea pea kei ngā tāone iti, kei ngā tāone tuawhenua rānei ngā wāhi CBME, ā, kei reira ngā ākonga e pāngia ana e ngā āhuatanga kawe waka uaua, ā, he whai wāhi rātou ki te taunekeneke ki ngā tāngata i roto i aua taiao. I whakahuatia anō hoki ko te ahotea, te mokemoke pāpori, te mahi me te kai, e pāngia ana e te nuinga o ngā ākonga i roto i te mahi. I tētahi atu taha, he uaua pea te mārama ki te pānga o te kore taurite pāpori me te kore mahi ki te hauora i roto i tēnei wā poto o te ako. Ko ngā āhuatanga SDH e tūtaki ana ngā ākonga i roto i te mahi, ka whakawhirinaki pea ki ngā āhuatanga o te wāhi mahi.
He mea nui tā mātou rangahau nā te mea kei te arotake tonu mātou i te kaupapa SDH i roto i te kaupapa CBME e tukuna ana e mātou ki ngā ākonga hauora paetahi mā te aromatawai i te taumata o te whakaaroaro i roto i ngā pūrongo a ngā ākonga. Ko ngā ākonga hauora matua kua roa e ako ana i te rongoā haumanu he tirohanga hauora. Nō reira, kei a rātou te kaha ki te ako mā te hono i ngā pūtaiao pāpori e hiahiatia ana mō ngā kaupapa SDH ki ō rātou ake tirohanga hauora [14]. Nō reira, he mea tino nui te whakarato i ngā kaupapa SDH ki ēnei ākonga. I roto i tēnei rangahau, i taea e mātou te whakahaere i te aromatawai tonu o te kaupapa mā te aromatawai i te taumata o te whakaaroaro i roto i ngā pūrongo a ngā ākonga. Campbell et al. E ai ki te pūrongo, ka arotakehia e ngā kura hauora me ngā kaupapa āwhina tākuta o Amerika ngā kaupapa SDH mā roto i ngā rangahau, ngā rōpū arotahi, ngā raraunga aromatawai waenga-rōpū rānei. Ko ngā paearu ine e whakamahia whānuitia ana i roto i te aromatawai kaupapa ko te urupare me te makona o ngā ākonga, te mōhiotanga o ngā ākonga, me te whanonga o ngā ākonga [9], engari kāore anō kia whakatūria he tikanga paerewa me te whai hua mō te aromatawai i ngā kaupapa mātauranga SDH. E whakaatu ana tēnei rangahau i ngā huringa roa i roto i te aromatawai kaupapa me te whakapai tonu i te kaupapa, ā, ka whai wāhi ki te whanaketanga me te aromatawai i ngā kaupapa SDH i ētahi atu whare wānanga.
Ahakoa i tino piki ake te taumata whakaaroaro whānui a ngā ākonga puta noa i te wā ako, he iti tonu te ōwehenga o ngā ākonga e tuhi ana i ngā pūrongo whakaaroaro. Me whakawhanake pea ētahi atu huarahi pāpori hei whakapai ake. Me whakauru e ngā ākonga ngā tirohanga pāpori me te hauora i roto i ngā mahi i roto i te kaupapa SDH, he rerekē te uauatanga ki te tauira hauora [14]. E ai ki tā mātou i kōrero ake nei, he mea nui kia whakaratohia ngā akoranga SDH ki ngā ākonga kura tuarua, engari ko te whakarite me te whakapai ake i ngā kaupapa mātauranga e tīmata ana i te tīmatanga o te mātauranga hauora, te whakawhanake i ngā tirohanga pāpori me te hauora, me te whakauru i aua mea ka whai hua ki te whakatairanga i te ahunga whakamua o ngā ākonga. 'whakawhanake. Te mārama ki te SDH. Tērā pea ka āwhina te whakawhānui ake i ngā tirohanga pāpori a ngā kaiako ki te whakanui ake i te whakaaroaro a ngā ākonga.
He maha ngā herenga o tēnei whakangungu. Tuatahi, i herea te wāhi ako ki tētahi kura hauora i Hapani, ā, i herea te wāhi CBME ki tētahi rohe i te tāone iti, i te taiwhenua rānei o Hapani, pērā i ā mātou rangahau o mua [13, 14]. Kua whakamāramahia e mātou te papamuri o tēnei rangahau me ngā rangahau o mua me te taipitopito. Ahakoa ēnei herenga, he mea tika kia mōhio kua whakaaturia e mātou ngā hua mai i ngā kaupapa SDH i roto i ngā kaupapa CBME i ngā tau. Tuarua, i runga i tēnei rangahau anake, he uaua ki te whakatau i te whaihua o te whakatinana i te ako whakaaroaro i waho o ngā kaupapa SDH. Me whai rangahau anō hei whakatairanga i te ako whakaaroaro o te SDH i roto i te mātauranga hauora paetahi. Tuatoru, ko te pātai mēnā kei tua atu i te whānuitanga o ngā whakapae o tēnei rangahau te whai wāhi o te whanaketanga o ngā kaiako ki te whakapai ake i te kaupapa. Me whai rangahau anō me te whakamātautau i te whai huatanga o te hanga tīma kaiako.
I whakahaerehia e mātou he aromatawai roa mō te kaupapa mātauranga SDH mō ngā ākonga hauora matua i roto i te marautanga CBME. E whakaatu ana mātou kei te hohonu haere tonu te māramatanga o ngā ākonga ki te SDH i te pakeketanga o te kaupapa. Tērā pea ka hiahiatia he wā me he kaha hei whakapai ake i ngā kaupapa SDH, engari ka whai hua pea te whakawhanaketanga kaiako e aro ana ki te whakanui ake i te māramatanga o ngā kaiako ki te SDH. Hei whakapai ake i te māramatanga o ngā ākonga ki te SDH, me whakawhanake pea ngā akoranga kua whakaurua ake ki roto i ngā pūtaiao pāpori me te rongoā.
Kei te wātea mai ngā raraunga katoa i tātarihia i te wā o te rangahau o nāianei i te kaituhi e pā ana mēnā he tono tika.
Te Whakahaere Hauora o te Ao. Ngā āhuatanga pāpori e whakatau ana i te hauora. Kei te wātea mai i: https://www.who.int/health-topics/social-determinants-of-health. I uru atu i te 17 o Noema, 2022
Braveman P, Gottlieb L. Ngā take pāpori e pā ana ki te hauora: Kua tae ki te wā ki te titiro ki ngā take. Public Health Reports 2014; 129: 19–31.
2030 Ngā tāngata hauora. Ngā mea pāpori e whakatau ana i te hauora. Kei te wātea mai i: https://health.gov/healthypeople/priority-areas/social-determinants-health. I uru atu i te 17 o Noema, 2022
Te Komihana Whakangungu i ngā Tohunga Hauora hei Whakatika i ngā Āhuatanga Hapori o te Hauora, Te Komihana Hauora o te Ao, Te Whare Rongoā, Ngā Kura Tuarua o te Motu mō ngā Pūtaiao, te Hangarau, me te Rongoā. He pūnaha mō te whakangungu i ngā tohunga hauora hei whakatika i ngā āhuatanga pāpori o te hauora. Washington, DC: National Academies Press, 2016.
Siegel J, Coleman DL, James T. Te whakauru i ngā āhuatanga pāpori e whakatau ana i te hauora ki roto i te mātauranga hauora paerua: he karanga ki te mahi. Te Kura o ngā Pūtaiao Hauora. 2018;93(2):159–62.
Te Kāreti Ariki o ngā Tākuta me ngā Taote Pokanga o Kanata. Te hanganga o CanMEDS. Kei te wātea mai i: http://www.royalcollege.ca/rcsite/canmeds/canmeds-framework-e. I uru atu i te 17 o Noema, 2022
Lewis JH, Lage OG, Grant BK, Rajasekaran SK, Gemeda M, Laik RS, Santen S, Dekhtyar M. Te aro atu ki ngā take pāpori e pā ana ki te hauora i roto i ngā marautanga mātauranga paetahi Mātauranga Hauora: Pūrongo Rangahau. Te mahi o te mātauranga hauora teitei. 2020;11:369–77.
Martinez IL, Artze-Vega I, Wells AL, Mora JC, Gillis M. Tekau mā rua ngā tohutohu mō te whakaako i ngā āhuatanga pāpori e whakatau ana i te hauora i roto i te rongoā. Te whakaakoranga hauora. 2015;37(7):647–52.
Campbell M, Liveris M, Caruso Brown AE, Williams A, Ngongo V, Pessel S, Mangold KA, Adler MD. Te aromatawai me te aromatawai i ngā āhuatanga pāpori o te mātauranga hauora: He rangahau ā-motu mō ngā kura hauora me ngā kaupapa āwhina tākuta o Amerika. J Gen Trainee. 2022;37(9):2180–6.
Dubay-Persaud A., Adler MD, Bartell TR Te whakaako i ngā āhuatanga pāpori e whakatau ana i te hauora i roto i te mātauranga hauora paerua: he arotake whānui. J Gen Trainee. 2019;34(5):720–30.
Te Manatū Mātauranga, Ahurea, Hākinakina, Pūtaiao me te Hangarau. Tauira marautanga matua mō te mātauranga hauora i whakahoutia i te tau 2017. (Reo Hapanihi). Kei te wātea mai i: https://www.mext.go.jp/comComponent/b_menu/shingi/toushin/__icsFiles/afieldfile/2017/06/28/1383961_01.pdf. I uru atu: Hakihea 3, 2022
Te Manatū Mātauranga, Ahurea, Hākinakina, Pūtaiao me te Hangarau. Marautanga Matua Tauira Mātauranga Hauora, Arotakenga 2022. Kei te wātea mai i: https://www.mext.go.jp/content/20221202-mtx_igaku-000026049_00001.pdf. I uru atu: Hakihea 3, 2022
Ozone S, Haruta J, Takayashiki A, Maeno T, Maeno T. Te māramatanga o ngā ākonga ki ngā āhuatanga pāpori e whakatau ana i te hauora i roto i tētahi akoranga ā-hapori: he huarahi whānui hei tātari raraunga kounga. BMC Medical Education. 2020;20(1):470.
Haruta J, Takayashiki A, Ozon S, Maeno T, Maeno T. Me pēhea te ako a ngā ākonga hauora mō te SDH i roto i te hapori? Rangahau kounga mā te whakamahi i te huarahi tūturu. Te whakaakoranga hauora. 2022:44(10):1165–72.
Tākuta Thomas. He huarahi whānui hei tātari i ngā raraunga aromatawai kounga. Ko Jay Eval tōku ingoa. 2006;27(2):237–46.
Aronson L. Tekau mā rua ngā tohutohu mō te ako whakaaroaro i ngā taumata katoa o te mātauranga hauora. Te whakaakoranga hauora. 2011;33(3):200–5.
Te Whare Wānanga o Reading. He tuhituhi whakaahua, tātari me te whakaaroaro. Kei te wātea mai i: https://libguides.reading.ac.uk/writing. Whakahōungia i te 2 o Hānuere, 2020. I uru atu i te 17 o Noema, 2022.
Hunton N., Smith D. Te whakaaroaro i roto i te mātauranga kaiako: te whakamāramatanga me te whakatinanatanga. Whakaako, whakaako, whakaako. 1995;11(1):33-49.
Te Whakahaere Hauora o te Ao. Ngā Take Pāpori e Āhua Ana ki te Hauora: Ngā Mea Tūturu. putanga tuarua. Kei te wātea mai i: http://www.euro.who.int/__data/assets/pdf_file/0005/98438/e81384.pdf. I uru atu: 17 o Noema, 2022
Michaeli D., Keogh J., Perez-Dominguez F., Polanco-Ilabaca F., Pinto-Toledo F., Michaeli G., Albers S., Aciardi J., Santana V., Urnelli C., Sawaguchi Y., Rodríguez P, Maldonado M, Raffic Z, de Araujo hauora MO, Michael a ni COVID-19. whenua. International Journal of Medical Education. 2022;13:35–46.
Wā tuku: Oketopa-28-2023