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In recent years, the number of immigrants who come to Canada seeking health care has increased. The study had three objectives: (1) describe how some African immigrant/refugee women living in Manitoba access perinatal and maternal health care services; (2) describe their interactions with health care providers and (3) describe how their experience impacts their treatment adherence. The study utilized principles of community-based participatory research in partnership with Sexuality Education Resources Centre Manitoba (SERC) representative leaders. Purposive and snowball sampling methods were used to recruit 16 women from SERC and local African community organizations. Data collection included in-depth interviews, and analysis was based on interpretative phenomenological analysis (IPA) and intersectionality from a black feminist tradition. IPA facilitated the description of meanings provided by the women of their experiences and intersectionality enabled to highlight issues such as how perceived racism can intersect with being immigrants/refugees facing unique challenges while accessing health care. The participants shared accessing these services through Mom and Me program, clinics, and family doctors. The women who arrived while pregnant or became pregnant within the first two years of their stay in Winnipeg experienced barriers such as language differences and lack of social support. Some of the main themes that emerged from the women’s experiences with accessing care included: it was tough, trying to understand and left hanging. The women described positive and negative experiences with health care providers. The lack of understanding of the health care system led the women feeling unsure if their experience was due to racism/discrimination or to structural barriers. The women also shared not following some recommendations due to their traditional/cultural way of caring for a newborn. To our knowledge this is the first study that focused on African immigrant/refu

Introduction Current Canadian guidelines recommend that all individuals living with Hepatitis C virus (HCV) be considered as candidates for HCV treatment, though treatment uptake in Manitoba remains limited. Access to HCV treatment requires a specialist referral in Manitoba, and the availability and location of specialists may serve as a barrier to HCV treatment. A potential solution to improving access to HCV treatment is through the use of a novel electronic consultation platform (eConsult). Using eConsults, primary care providers (PCPs) can link to HCV specialists through electronic means and receive specialist advice directly, without the need for a face-to-face patient visit. We aimed to characterize the impact of using the eConsult platform as it relates to HCV treatment in Manitoba, situated within a rich description of the local provincial context and perspectives of relevant stakeholders. Methods This was a single case study design that took place at Nine Circles Community Health Centre, utilizing a sequential explanatory mixed methods design. Chart reviews were conducted for individuals referred for HCV treatment via a traditional referral between December 1, 2016 and December 1, 2017; and for individuals referred via eConsult between December 2017 and December 31, 2019. Stakeholder interviews were completed with two PCPs, as well as the sole HCV specialist who received HCV treatment referrals. Results Individuals referred for HCV treatment via eConsult were more likely to be linked to specialist care (100% vs. 69%, p = 0.026), and complete HCV treatment (79% vs. 36%, p = 0.049). The time from referral to achieving each step of the HCV cascade of care was shorter for individuals referred via eConsult. A modified access to care framework was able to capture elements of availability; accessibility; accommodation; affordability; acceptability; and awareness that facilitated or created barriers to the success of eConsult. Additional themes of agility; adaptabi

Objective: To conduct a process evaluation of a pilot intervention program, culturally adapted using a Two-eyed Seeing approach, and designed specifically for Indigenous mothers and their school-aged children who have been impacted by intimate partner violence (IPV) and who are living in Calgary, Alberta in Treaty 7 Territory. Background: IPV perpetuated against Indigenous women in Canada is a persistent public health issue and human right abuse, with serious impacts for women, their children, their families, and society as a whole. Alberta ranked fourth highest among the ten provinces in 2020 for its rates of IPV and services, including Calgary’s shelters, are bursting at capacity. Sorely lacking is programming that is a) culturally integrated for an Indigenous population, b) evidence-based, c) specific to IPV, and d) being delivered to both mothers and their children concurrently. Research Design: The first research question addressed the perspectives of and lessons learned by those involved in the adaptation process. The second question investigated how the culturally responsive elements or concepts of the adapted programs were chosen, particularly around fit, familiarity, and meaningfulness. The results shone a light on how the effort to build relationships, renegotiate power, and integrate Indigenous cultural representation would come to define how the process through it went for the team. Six themes were identified from the transcripts: Power, Adaptation Barriers, Relationship Building, The Learning Journey, Integrating Indigenous Cultures, and Outcomes of the Adaptation Process. Conclusion: Bringing to light the experiences of those involved in this adaptation process, allowed for a deeper understanding of the positive and negative aspects of how the process unfolded, and provided clear recommendations concerning how others may undertake a similar process for their own communities. Creating a map of how it can be done is one way research becomes reciprocal wi

Introduction: African, Caribbean, and Black (ACB) women in Manitoba are overrepresented in HIV infections relative to other racial groups. Yet, there are no community-based or participatory studies that have explored the stories of these women. The goal of this study was to explore how ACB women living with HIV in Winnipeg experience care and support to call attention to their lived realities, including highlighting the historical and cultural oppressions. Methods: Study participants were ACB women living with HIV (n=10) in Winnipeg, as well as healthcare staff (n=12). The qualitative research design was informed by critical race and feminist theoretical frameworks, incorporating intersectionality and constructivist grounded theory methodology for data generation, organization, and analysis. This study was also community-based and collaborated with several HIV-focused clinics in Winnipeg. The study focused on providing insight and developing a theoretical lens into the experiences of HIV care and support by HIV-positive ACB women through in-depth, semi-structured face-to-face and phone interviews. Results: Study findings revealed the specific life histories and themes of ACB women in Winnipeg, particularly highlighting trauma that informs and shapes their experiences. ACB women with HIV in Winnipeg and their care staff also expressed a lack of cultural care and support, how ACB women bear multiple loads, face language problems, experience long waiting times, and do not feel welcomed, including dealing with the cost of HIV medication. Findings show that the difficulties ACB women face involve multiple intersecting forms of oppression within social and health services and are at various levels. At the same time, ACB women commit to using HIV care, self-accepting their HIV-positive identity, connecting with religion and spirituality, and creating a stronger sense of themselves in order to live well with their condition. Implications: This study generates new

Background: Though growing, the body of 2SLGBTQIA+ health research is small and privileges the experiences of white, gay and bisexual men, and lesbians. Further, research regarding the healthcare experiences of transgender individuals is dominated by binary gender identities, and little is known about the true prevalence of gender diversity. Research with the 2SLGBTQIA+ community has found this population is at increased risk for adverse health outcomes such as problematic drug use, domestic violence, depression, anxiety, and suicidal ideation. Primary healthcare cannot be utilized as a pathway to risk reduction if primary care practitioners (PCPs) are operating under heterocisnormative assumptions. Young adults (ages 19-30) have a whole life of healthcare needs ahead of them. Examining their unique experiences as young adults and members of the 2SLGBTQIA+ community can help to improve the quality of care they receive from their providers. Decreased utilization of primary healthcare because of barriers, such as discrimination, results in a reduction of preventative care that can be offered to patients. By dismantling barriers early in the life course, patients can safely engage with primary care and improve their long-term health outcomes. Objectives: Significant knowledge gaps exist in the research literature with regards to who among the 2SLGBTQIA+ community is represented in health research. No studies in the literature review specifically investigated the experiences of demisexual, asexual, pansexual, or polysexual individuals and none contained any consideration of romantic identity as a separate identity. The present study sought to begin to fill these gaps by listening to the voices of historically underrepresented 2SLGBTQIA+ community members by including a broader range of gender identities, sexual orientations, and romantic orientations, asking the research question: What are the primary healthcare experiences and needs of underrepresented young adults of

Background: The overall incidence of substance use for individuals during childbearing years is rising. Pregnant individuals who use substances commonly have complex circumstances and face barriers such as systemic racism and judgment when health care services are accessed. Interprofessional care models and provider approaches driven by patient perspectives is a necessity in effort to provide best practice. Purpose: The purpose of this thesis was to critically examine interprofessional maternity care models among pregnant individuals and women who use substances. A sequential research study was undertaken. Phase 1 involved a scoping review of the literature. This led to Phase 2 an exploratory, qualitative design informed by the five processes of appreciative inquiry. Patient participants who received perinatal care from an interprofessional care team (midwife, obstetrician, and psychiatrist) participated in one-on-one semi-structured interviews. Data analysis was guided by thematic analysis along with on-going consultation provided by Knowledge Carrier and Grandmother Shingoose. Methods: The scoping review was conducted to systematically search for articles from seven health-related databases. Eleven articles met full inclusion criteria and were summarized. Optimal care models for pregnant individuals who use substances exist and reported improved maternal and neonatal outcomes. Interprofessional care teams all included a maternity provider along with other various care providers and aimed to provide continuity of care from prenatal through postpartum. A few care provider characteristics that were identified on the interprofessional care teams included: nonjudgmental, trustworthy, respectful, and relational. The qualitative research took place in a clinic setting that offered interprofessional care for pregnant individuals who use substances. There were 14 participants who participated in semi-structured interviews and shared their insights and experiences regarding

Introduction: In 2021, 1.5 million new Human Immunodeficiency Virus (HIV) infections occurred. Inflammation increases HIV risk; decreased inflammation is associated with protection in HIV-exposed seronegative (HESN) individuals who remain HIV seronegative despite repeated exposures. Understanding how behaviours/interventions alter inflammation is crucial and is the basis of this thesis. Aim 1: The Sniffing Around the Issue Study (SUS, 2015-2023) assessed the effect of solvent use on inflammation. Aim 2: The Inducing Immune Quiescence Study (IIQ, 2013-2022) assessed the ability of anti-inflammatory drugs, acetylsalicylic acid (ASA) and hydroxychloroquine (HCQ), to induce the HESN-like phenotype. Methods: Blood/plasma were collected in both aims. Aim 1: SUS enrolled 27 individuals – 14 solvent users and 13 community-matched controls. Immune cell phenotypes/functions, markers of microbial translocation, and cytokines/chemokines/hormones were measured. Aim 2: IIQ enrolled women (ASA:38, HCQ:39) with samples pre-/post-drug. Immune cell phenotypes/functions, antibody levels, oxylipin levels, and in vitro phosphorylation and cell migration were assessed. Both studies utilized integrated knowledge translation and community engagement which required pre-study/mid-study/post-study engagement. Results: Aim 1: Solvent users had increased natural killer (NK) cell activation, exhaustion, cytokine production, and degranulation with reduced KIR expression following stimulation. T cells exhibited altered cytokine response (increased on Th1 and Th1/Th17 and reduced on Th2 and CCR4+CCR6+ T cells) post stimulation. Solvent use reduced free thyroid hormone T3/T4 levels. For those in the IIQ study HCQ altered T cell trafficking, suppressed recall memory T cell responses, and decreased total IgG levels. ASA reduced T cell trafficking markers and total IgG levels. ASA enhanced recall memory T cell responses and NK activation without affecting NK function. ASA reduced levels of cyclooxygena

Persons with intellectual and developmental disabilities (IDD) are found to be at a greater risk for social isolation during COVID-19 pandemic. While existing literature has examined the challenges faced by persons with IDD, there is a dearth of research that addresses the access and usage of digital technologies by persons with IDD as a solution to stay socially connected during the pandemic. This study therefore investigated the access to and use of digital technologies such as the internet in relation to the risk of social isolation experienced by persons with mild intellectual disabilities ID (with or without developmental disabilities) during the COVID-19 Pandemic in Manitoba. Additionally, barriers to the usage of online technology were explored. Data for a sample of 39 adults were collected using an online survey questionnaire, and phone interviews. The key variables in this study are internet use, access to an electronic device, barriers to the internet usage, loneliness, and social isolation. Loneliness was measured using the Revised UCLA (University of California, Los Angeles) Loneliness Scale. To measure social isolation, the MSNA-ID (Maastricht Social Network Analysis – Intellectual Disabilities) tool was used. The study utilized both descriptive and inferential analyses to address the research objectives. We found that the majority of the study participants (89.5%), had access to the internet and possessed some form of electronic devices for online connection. The most commonly used devices were smartphones, desktop computers, and tablets. The majority of the study participants (67.6%) who had access to the internet and an electronic device used the internet for social connection during the COVID-19 pandemic. The majority of the study participants (53.8%) perceived that their internet usage made them feel less isolated. The use of the internet was associated with a feeling of less isolation. The results further revealed the most prevalent barriers to th

The presence of two or more chronic conditions in the same individual has increased over recent years among different population groups. Studies have indicated that multimorbidity affects many adults and youth and leads to the overuse of healthcare services. In Colombia, the available evidence shows that 19.5% of all patients suffered from several chronic conditions in 2012-2016. The Wayuu people are one of the approximately 115 Indigenous ethnic groups in Colombia, with an estimated population of 380,400 (20% of the Indigenous people in the country). Anas Wayuu (AW) is an Indigenous-led non-profit health insurance company that provides health coverage to Wayuu people and collects data to reimburse health care services. A retrospective cohort study was performed, including a cross-sectional multimorbidity descriptive analysis. Administrative health records from AW healthcare providers were used as the data source. The purpose of the study was to identify multimorbidity patterns amongst AW enrollees. The Agglomerative Hierarchical Cluster analysis was used. Generalized linear mixed models were fitted for model differences in the healthcare services use rates provided to enrollees. In total, 159,921 were enrolled in AW in 2014-2017. The descriptive results indicated greater multimorbidity prevalence in female and older populations. Multimorbidity patterns across subpopulations showed morbidity profiles with a higher prevalence of musculoskeletal conditions. Healthcare utilization assessment in 2018-2019 showed higher use among multimorbid patients suffering from circulatory illnesses, Indigenous females, and those living in urban areas. The evidence about multimorbidity may help identify chronic disease clusters requiring further epidemiological research on causes, prevention, and treatment. The evidence may also be helpful for healthcare services planning and delivery for AW. The study provides information about multimorbidity among the Wayuu people, contributing to

This study explores the need for a pre-service training program for Manitoba’s foster parents for the purposes of preparing and equipping foster parents with the skills necessary to respond to children with complex needs and to create stable placements for children in care. Current literature has found an increase in stable placements and fewer breakdowns when foster parents engage in a pre-service training program. Despite this, Manitoba is one of the only jurisdictions in the world that does not require such training. A total of 13 participants from three different groups (child welfare professionals, foster parents, and previous children in care) were interviewed using a semi-structured, one-on-one interview style. Both critical and standpoint theories were used as guiding theoretical frameworks and mainstream qualitative research design was used for data analysis. Significant findings include that all 13 participants supported a pre-service training program in Manitoba. Most foster parents in this study Manitoba felt unsupported and unprepared for their roles as caregivers to children with complex needs. This finding was corroborated by child welfare professionals, and from previous children in care. The participants provided training recommendations, including communication and documentation, a more comprehensive orientation, a systems training, and child-focused training.

Background: Risk prediction models for cardiovascular disease (CVD) hospitalization have improved prediction accuracy when individual-level measures of socioeconomic status (SES) are considered. However, it is unclear how validated, area-level SES measures, available at the population-level in Canada, might improve prediction of CVD hospitalization. Objectives: The research objectives were to (1) test the incremental predictive value of area-level SES measures and (2) compare the incremental predictive performance of different area-level SES measures on time to hospitalization for CVD. Methods: A retrospective cohort design used Manitoba administrative health records from 2014 to 2020 and area-level SES measures from 2016 Statistics Canada Census data. Individuals 40+ years as of April 1st, 2016 were followed until an acute myocardial infarction (AMI) or stroke hospitalization or loss to follow-up. Covariates included age, sex, comorbid conditions, prior healthcare use, AMI/stroke-related prescription medications, and one or more area-level SES measures, including the Socioeconomic Factor Index - Version 2 (SEFI-2), Material Deprivation Index, Social Deprivation Index, and the Canadian Index of Multiple Deprivation (CIMD). Cox proportional hazards models were assessed for model accuracy (area under the curve; AUC), discrimination (net reclassification improvement; NRI and integrated discrimination improvement; IDI) and calibration (Brier score). Results: Overall predictive performance of models containing one or more SES measures (fully-adjusted model; AUC = 0.753 – 0.757) was similar to model containing all other covariates (partially-adjusted model; AUC = 0.753). Discrimination performance was poor or statistically non-significant (NRI = -0.158 – 0.019; IDI = < 0.000). Prediction error was low for all models (Brier score = 0.022). Conclusion: Area-level SES measures did not add predictive value to CVD hospitalization risk models. Risk factors available in administ

Food and nutrition insecurity are public health issues in Canada that greatly impact health and well-being. Food security is a necessary condition for an adequate diet but is not enough on its own to ensure optimal growth and development. Nutrition security is an additional and necessary condition. While evidence suggests that newcomer youth may have extra vulnerability to food and nutrition insecurity, population growth continues to be supported through immigration without clear strategies to protect the right to food. This study used an observational cross-sectional design to collect survey data from 1,347 grade nine Manitoba students. Using the WEB-Q online survey, students responded to a 24-hour diet recall and questions related to experiences of food insecurity, eating behaviours, and self-reported health. Food security status was determined through responses to the Child Food Security Survey Module. The 24-hour recall was used to assess diet quality through a derived Healthy Eating Index – Canada score and adherence to dietary recommendations. Descriptive statistical analyses were performed. Further analyses compared differences between newcomer and other study participants. Eighteen percent of newcomer participants were food insecure. Regardless of food security or newcomer status, very few participants had a ‘good’ overall diet quality. Participants were particularly poor at meeting recommendations for vegetables and fruit, fibre, calcium, and vitamin D. More males met recommendations for milk and alternatives, and iron intake. Females consumed more servings of whole fruit, and dark green and orange vegetables. There were no differences found between newcomer status for overall diet quality. However, a smaller proportion of newcomer youth met recommendations for vegetables and fruit, calcium, and iron. Further, a greater proportion of newcomer youth changed their eating behaviours to gain or lose weight. There were no differences found for self-reported heal

The study sought to explore and understand how the Tugen (a Nilotic sub-group of the Kalenjin speaking groups of Kenya who practice both farming and livestock keeping), of Kisanana, Kenya, sustain peace in day-to-day life. Specifically, the research aimed to answer the following research questions: (i) how do the integral elements of culture shape the community’s pathways towards sustained peace?; (ii) how does culture influence the community’s perceptions and experiences of conflict and the community’s response mechanisms to conflict?; and (iii) how does the fulfillment of community members’ basic needs and the needs for autonomy and bonding/belongingness lead to sustained peace? The study was conducted using ethnographic fieldwork techniques, including participant observation, individual and group interviews, and focus group discussions. The findings showed that ideological culture prevents conflicts over property and that culture influences how the group perceives and experiences conflict. Additionally, conflicts that occur in families and in the community are mitigated within the community at the level in which they occur ranging from the family level, inter-clan level, and the communal level. The findings also showed that peace among the Tugen is achieved when community members’ basic needs (food, clothing, shelter) and psychological needs (autonomy and bonding / belonging) are met within the family and the community at large. This study adds to existing literature on culture and conflict, cultures of peace, Indigenous processes of peacemaking, and human needs and cultures’ orientation towards peacefulness.

The goal of the study was to explore the lived experiences and parental perceptions of families with children who are immunosuppressed following paediatric solid organ translation. The research questions sought to generate new knowledge and understanding of the following: how families manage acute and chronic stress; how families manage the accumulation of stress; how their functioning is impacted by the immunosuppression and the related recommendations; what are the challenges that they face as immunosuppressed families; and what are the strengths of the children and their families? Study participants were families living across two provinces in Canada (Manitoba and Saskatchewan), who have a child who is immunosuppressed long-term following a paediatric solid organ transplant. The research design was qualitative autoethnography as well as interpretative phenomenological analysis, which utilized the family stress theory and the double ABC-X model within the analysis. The study focused on providing insight and developing a theoretical lens into how different facets of immunosuppression may impact families in all areas of functioning post-transplant, including those identified within the social determinants of health. The findings suggested families experienced stress and financial implications as individual concerns, and vaccine hesitancy and the current state of the organ registry as systemic concerns. Study participants indicated a need for more accessible supports for families, such as family counselling. A preliminary framework was created based on the findings of the study, in order to guide clinicians during the initial assessment of families entering into the transplant procedures to determine their inventory of current resources, their ability to access additional resources, and whether or not the family may be vulnerable to crisis and mal-adaptation, as a means to provide more holistic care to families.

Statement of the Problem: Yoga is a 27-billion-dollar industry in North American which is deeply rooted in capitalism, racism, and colonialism. The removal of spirituality from yoga in the Western world with the ascendency of the modern postural yoga movement in particular in Canada has been and continues to be harmful to yoga’s grounding in Jain history, and more generally to South Asian social and cultural development, and in particular to Jain diasporic women born and raised in Canada, such as myself. I argue that marginalized mothers are a group of people that could be re-centered through a practice of yoga as they are broadly impacted negatively because of race, gender, sexuality, class, and/or abilities within a present-day culture. Theoretical Framework and Research Questions: Decolonization is presented as the theoretical framework used to examine yoga through the lenses of both feminism and culture. The research questions were: (1) What is the theoretical foundation of feminist-informed yoga in contemporary culture? (2) What are some of the ways in which a feminist-informed yoga can be applied as a healing approach to various populations of marginalized mothers in a mid-sized Canadian city? Methods: I use a research method known as autoethnography that recognizes the reciprocal relationship between theory and story. Data collection includes a lay summary, journaling, yoga and meditation, text spinning, and collaging. Data analysis focuses on making sense of the story, my writing, and included thematizing, daily writing, theorizing the story, considerations of the story and editing. Findings: For research question one; I developed a theoretical foundation of feminist-informed yoga as practiced by me in contemporary culture, which included the yoga traditions, cultural appropriation, spiritual materialism, and commodification as central to its theoretical foundation along with trauma and addictions For research question two, feminist-informed yoga as

This research was initiated as a small step towards actioning local sustainability, with the aim of contributing to solutions for overarching natural resource and environmental management (NREM) issues. Community-based environmental assessment (CBEA) is community-driven and focuses on participatory approaches to determining the environmental and social implications of local projects, and, as such, confronts many current NREM challenges in the context of smaller, rural development projects. Next generation CBEA, drawing on next generation EIA principles, such as sustainability, meaningful public participation, follow-up and monitoring, and learning, was tested in my research to determine if it is better equipped to action local sustainability for small-scale projects than even CBEA. I conducted my research in two phases. In the first phase, I undertook key informant interviews with academics and EIA practitioners and made a field visit to Kenya to better understand CBEA in the local context and to establish potential case studies. This work helped me design a next generation CBEA architecture and develop a frame that included the steps for implementation. The second phase of my research focused on testing the next generation CBEA frame, which required collaboration among different agencies, such as NEMA (National Environment Management Authority, Kenya), licensed EIA experts, the project proponents, and community members. Once the initial linkages were established, I tested the potential of the next generation CBEA frame by implementing it in two different case study sites in Kenya. During the pre-CBEA phase, I spent additional time to understand the local context and build capacity among the CBEA participants to set the foundation for the actual CBEA. Three key conclusions were drawn from the research here: i. role of the pre-CBEA phase in next generation CBEA is crucial since the advanced form of CBEA requires preparation for the successful integration of next gene

St.Amant provides services and supports to persons with intellectual and developmental disabilities (IDD) and their families in Manitoba. This agency is undergoing major service transformations to provide the most inclusive and supportive care possible in the community. Since 2014, over 50 persons with IDD have moved from St.Amant’s main facility to family and agency-supported homes. A replicative case study was conducted to explore families’ experiences regarding the community transitions of their children. Four families participated in the study. It was found that although the majority of families (75%) were initially against community transitions, they were highly involved and satisfied with the process of community transitions. Community transitions did not have any effect on the families’ quality of life, however, most of them were happy with the social life of their children in the community. Families made a number of suggestions including increased wage and better training for direct support staff.

Type 2 diabetes mellitus (T2DM) is the leading cause of death in Belize, and its prevalence is rapidly increasing. The purpose of this study is to understand the everyday realities of people living with T2DM in Belize (e.g., barriers to care, strengths, health practices), how these affect diabetes self-management (DSM), and implications for health care. Data generation methods include interviews with T2DM patients, discussions with key informants, field notes, and participatory observation which took place in February and March of 2020. Principal findings were categorized into three main themes. The first is that patients experience numerous difficulties, including a tiered health care system privileging those with more resources, communication barriers with health care providers, and major gaps in prevention, education, and social supports. Secondly, many Belizeans with T2DM engage in spiritual practices that provide for mental strength, stress relief, lifestyle guidance, overcoming addictions, overcoming denial, and building determination toward health promoting, life-affirming attitudes and actions. Further, geographies can empower DSM. Home is a domain where personal power is most focused. A community domain that is conducive to active living is crucial. People use a plethora of local plant medicines instead of, alongside of, or to complement pharmaceuticals for DSM without disclosure to HCPs. Plant medicine usage and cultural-spiritual healing is pervasive in this population; therefore, health care can optimize T2DM outcomes through open dialogue and collaboration with patients, herbal doctors, traditional Indigenous medicine practitioners, community leaders, and faith leaders. Integrating these understandings will be key for moving forward to improve DSM education and support, as well as culturally safe care.

The early identification and treatment of children with conduct disorder (CD) help in preventing future engagements in criminal activities. Literature shows that cognitive-behavioural treatments (CBT) may have desirable results in children under 12 years of age with CD. Stop Now, And Plan (SNAP) as one of the CBT interventions is provided in community settings for children under 12 who act antisocially and aggressively. Some primary studies have been conducted to evaluate the SNAP program’s effectiveness. These evaluations have shown the program’s effectiveness in reducing aggressive, conduct, rule-breaking, antisocial, and overall behavioural problems. The purpose of the study was to conduct a Meta-Analysis that combines data from the SNAP primary evaluation studies to produce a precise total estimate of the program effect. Specifically, the study aimed to (1) determine the effect of SNAP program on the children’s CD in community settings, and (2) determine whether variations in treatment intensity and fidelity affect the program’s outcomes. The outcome summary data from each study that met the inclusion criteria were extracted by using a standardized data extraction form and were meta-analyzed by using the Review Manager. The Random-Effect Meta-Analysis methods were used. The study’s results showed that the SNAP program made a significant moderate reduction in the children's conduct problems (the summary effect size is 0.41 with 95% CI of 0.25 to 0.57, I2 of 58%, and based on four studies with 231 participants) immediately after they participated in the program. This trend has continued to a significant large effect after six months of follow-up with a summary effect size of 0.61, 95% CI of 0.44 to 0.99, I2 of 64%, and based on four studies with 318 participants. The results also showed that the program had a significant reduction in children’s externalizing and internalizing behavioural problems as well as significant improvements in prosocial skills, immediately