The Influence of Religion On Sustainable Consumption
The Influence of Religion On Sustainable Consumption
The Influence of Religion On Sustainable Consumption
Review
The Influence of Religion on Sustainable
Consumption: A Systematic Review and Future
Research Agenda
Anabel Orellano 1, * , Carmen Valor 2 and Emilio Chuvieco 1
1 Environmental Ethics Chair, Department of Geology, Geography and the Environment, University of Alcalá,
C/Colegios, 2, 28801 Alcalá de Henares, Spain; emilio.chuvieco@uah.es
2 E-SOST Research Group, Marketing Department, Management School, Universidad Pontificia Comillas,
c/Alberto Aguilera, 23, 28015 Madrid, Spain; cvalor@comillas.edu
* Correspondence: anabel.orellano@uah.es
Received: 28 August 2020; Accepted: 22 September 2020; Published: 24 September 2020
Abstract: Background: Due to the current environmental crisis, sustainable consumption (SC)
behaviour and its drivers has gained significant attention among researchers. One of the potential
drivers of SC, religion, have been analysed in the last few years. The study of the relationship
between religion and adoption of SC at the individual level have reached mixed and inconclusive
results. Methods: Following the PRISMA guidelines, a systematic review of articles published
between 1998 and 2019 was conducted using the Web of Science and Scopus databases. Search
terms included sustainable consumption, green consumption, ethical consumption, responsible
consumption, pro-environmental behaviour and religion. Results: This systematic review reveals
that contradictory results are due to methodological and theoretical reasons and provides a unifying
understanding about the influence of religion on SC practices. Results highlight the role of religion as a
distal or background factor of other proximal determinants of environmental behaviour. Conclusions:
This paper contributes to the literature concerning SC by synthesising previous scholarship showing
that religion shapes SC indirectly by affecting attitudes, values, self-efficacy, social norms and identity.
The review concludes with a research agenda to encourage scholars the study of other unexamined
mediating constructs, such as beliefs in after life, cleansing rituals and prayer, moral emotions, moral
identity, the role of virtues and self-restrain.
1. Introduction
The 2030 Agenda for Sustainable Development adopted by all United Nations Member States in
2015, aims to coordinate efforts to advance sustainable development. The 12th Sustainable Development
Goal promotes sustainable consumption and production patterns; one of its targets fosters educating
and engaging citizens on sustainable consumption and lifestyles. However, there are not clear
progresses to meet this Goal in view of the growing unsustainable consumption patterns [1,2]. For this
reason, understanding the drivers for sustainable consumption (SC hereafter) behaviour is becoming
increasingly important [3].
One of the such drivers that have received growing attention in the literature is religion. It is
estimated that 84% of the world’s population belong to a religious group [4]. Of this, approximately,
32% are Christians, 23% Muslims, 15% Hindus, 7% Buddhist, 0.2% Jews, 6% folk or traditional religions
and less than 1% others [4]. These religions are a significant source of wisdom, morality and ethics for
individuals [5,6].
In the last decade, environmental sciences have acknowledged the potential of religion to address
the ecological crisis [7]. Recently, environmental psychology has provided insights on how to enhance
behavioural change [8–10] pointing to the manifold routes whereby religion influences individual
perceptions, beliefs and practices [11]. As it has been long recognized in conservation psychology
“conservation without moral values cannot sustain itself. Unless we reach people through beauty,
ethics, spiritual, or religious values or whatever, we are not going to keep our wilderness areas” [12]
(p. 130).
Thus, religious beliefs, ideas and practices may be a driver for adoption of SC, by fostering salient
and inner motivations for behavioural change. Other scholarship has shown that religion is one of the
factors influencing consumer behaviours [13], and more specifically, consumer ethics [14], evaluation of
product quality [15], product pricing [16], and materialism [17]. In view of this evidence, it is plausible
to think that religion at the individual level may influence adoption of SC as well.
However, past studies have reached mixed, inconclusive, and contradictory results about the
relationship between individual’s religion and SC [18–21]. A systematic review may contribute to
reconcile these disparate results as it will clarify the relationship between these two constructs, and it
will identify the mediating variables that can explain why religion affects SC and the moderators or
boundary conditions of such influence [22].
This paper intends to enrich our understanding of the influence of religion on SC. Even though
religion may play a key role in the transition to more SC at an institutional level [23], at the organisational
level [24] and at the individual level, this study focuses on the latter as it examines the influence of
religion on the individual’s adoption of SC. As mentioned above, research on consumer behaviour
shows that religion can be considered an individual difference variable and recently, studies have
emerged addressing this influence on SC, but how this influence operates needs to be clarified. This is
in line with recent calls from psychology about the importance of understanding the individual
motivations that underpin behavioural processes leading to improved or constrained sustainable
lifestyles [9,12,25]. Our research aims to answer three research questions (RQ):
RQ 1: What is the relationship between religion and SC? Does this relationship change depending on
methodological issues (e.g., measurement of the constructs), the particular religion being studied,
or the country under examination?
RQ 2: What are the mediating variables or constructs whereby religion influences others proximal and
proven antecedent of SC?
RQ 3: Are there any moderators that weaken or strengthen the influence of religion on SC?
To achieve this goal, a systematic literature review was carried out, following the PRISMA
guidelines. Reported studies were grouped according to whether they analysed the direct or mediated
relationship between religion and SC. Thus, this review differentiates between studies treating religion
as a distal or background factor and those including mediating variables or proximal determinants of
environmental behaviour, following the socio psychological model proposes by Clayton and Myers [12].
This integrative model proposes two main sources of behaviour: internal (within the individual)
including knowledge, attitudes, values, emotions, responsibility and efficacy, and external (related to
the environment) including social norms, affordances, reinforcement contingencies, prompts, goals
and feedback.
This paper makes three contributions to the literature. First, this study concludes that the disparate
results of past studies are due to the limited consideration of the influences of the cultural context,
to methodological aspects regarding the measure of religion and to the insufficient theoretical support
of most studies. Second, this review contributes by proposing that religion should be treated as a
background factor influencing indirectly other proximal antecedents of behaviour. Finally, this paper
defends that, because of the complex nature of the relationship between the constructs examined,
approaches that consider a mediated relationship/moderating role of religion are needed as they can
Sustainability 2020, 12, 7901 3 of 21
provide a more accurate and comprehensive understanding of the psychological underpinnings of the
relationship between the constructs.
derive from a particular religion. In turn, as Mokhlis [38] points, religiosity can be measured with
different indicators, such as self-perceived level of religiosity [37], frequency of church attendance [39],
religious identity [40] or ad hoc scales. To illustrate, the Religious Commitment Inventory (RCI)
measures the degree to which a person is consistent with his/her religious values, beliefs, and practices
them in daily life [41].
Another fundamental distinction was established by Allport and Ross [42] between intrinsic and
extrinsic Religious Orientation, operationalized in the Religious Orientation Scale. Intrinsic religiosity
refers to the individual’s effort to internalize and fully follow a religious creed [42]. In contrast,
individuals with extrinsic religiosity use religion as a tool to increase their acceptance in particular
social environments [42]. The most used religious measures are summarized in Table 1.
3. Methods
excluded after full text reading. However, 4 new records identified by bibliographies of selected articles
were included. Finally, a total of 52 records were judged relevant and were selected for the analysis.
Sustainability 2020, 12, x FOR PEER REVIEW 5 of 20
proven determinants of behaviour, following the social psychological model of behaviour proposes by
Clayton and Myers [12].
4. Results
This section presents a synthesis of the most relevant insights classifying them according to
whether they have studied a direct or a mediated relationship between religion and SC.
• Some studies focused on religious and non-religious differences, finding that religious individuals
adopt SC to a greater extent have a more SC than less or non-religious ones [52–56], while others
proved the opposite [57–61].
• Other studies examined differences across faiths on the understanding that if White’s hypothesis
was right, it would not hold in Eastern religious followers (Buddhist and Hindi), as these religions
are not anchored on the dominion belief, according to White. This line of inquiry also resulted in
mixed findings: whereas some studies found that believers of Eastern religions were more likely
to carry out sustainable behaviours and hold more positive environmental views than Western
Sustainability 2020, 12, 7901 7 of 21
religious followers, Christians in particular [48,62], others found contradicting findings [63,64].
A similar conclusion was found in a global study comparing the environmental performance of
countries with different religions, concluding that similar values were found across Eastern and
Christian traditions [65].
Three reasons could explain these inconclusive outcomes: the concurrent influence of cultural
and country effects, methodological issues and theoretical reasons. First, different results are observed
between countries. These country differences point to the need to take into account the impact of the
complex cultural and geographical contexts where studies were carried out. Believers in the same
religion/individuals with a similar religious affiliation are considered to share a common cognitive
system of beliefs, values and expectations and are supposed to behave similarly [66]. However,
this assumption ignores the contextual influences that may explain why those sharing a religious
affiliation behave differently in different countries [67]. Following this rationale, cross-cultural studies
have shown that religion cannot be studied in isolation of other contextual influences. For example, in a
study carried out in the United States and South Korea [48], researchers found that not only religious
affiliation and religiosity but also the country and the interactions among the two, significantly predicted
sustainable behaviours. Similarly, another cross-country study in United States and Germany [47],
found remarkable differences between individuals of the same religion in these two countries: among
US respondents, a positive stronger correlation between religious attendance and ethical consumption
was found, whereas among Germans the relationship was negative and not significant. Researchers
explained this difference by pointing out a geographical effect: the US subsample was taken in
California, and this is one of the greenest states in the country.
A second reason for the contradictory results is the methodology employed, in particular the
conceptualization on which the measure of religion is based. Two observations are worth noting. First,
religion has been measured differently across studies and this dissimilar operationalization of the
construct implies that results cannot be integrated [68]. To illustrate, examining only religious affiliation,
the results show a negative [57] or positive [69] influence of religion on environmental attitudes and
behaviours. But when the measure of religion reflects the individual’s deeper commitment, such as the
self-perceived level of religiosity, results are different. Indeed, the self-perceived level of religiosity
has been found to positively correlate with self-reported sustainable household behaviours [54] and
behaviours such as avoid buying products, pay higher taxes and accept cut in living standards for
environmental reasons [70,71]. Reinforcing this argument, studies differentiating between an intrinsic
and extrinsic orientation to religiosity [42] have shown that intrinsic religiosity predict positive SC
outcomes while extrinsic religiosity does not [52,72,73].
Nonetheless, external religiosity could also predict SC [63,64], but the mediating mechanism is
different. While internal religiosity is linked to the inherent views and values provided by religion,
external religiosity would be a by-product of the intersection between public participation in religious
activities and local culture. However, the relationship between external religiosity and other constructs
makes it difficult to disentangle which of them is actually the cause of the behaviour so that it
is not possible to rule out that the relationship between external religiosity and SC is spurious.
Methodologically, using only affiliation as a measure of the construct should be discouraged as it does
not capture the degree to which its members accept the associated beliefs and practices.
A final reason for the inconsistent results is the limited theoretical grounding for the relationship
between religion and SC. Most of the studies testing a direct effect are empirical or data-driven and lack
a solid theoretical approach to explain the relationship. In contrast, studies that propose a mediating
relationship (31% of quantitative papers) are usually grounded on a theoretical framework. To these
studies we turn our attention next.
between these two constructs, 11 papers have defended a mediated relationship on the basis that
religion is a background factor that influence other proximal (and already proven) antecedents
of environment behaviour [74]; and/or proposes some moderators that weaken or strengthen the
religion-SC link. These behavioural antecedents are grouped into external and internal, as suggests the
social psychological model of behaviour by Clayton and Myers. This integrative model proposes two
main sources of behaviour: internal (within the individual) including knowledge, attitudes, values,
emotions, responsibility and efficacy, and external (related to the environment) including social norms,
affordances, reinforcement contingencies, prompts, goals and feedback [12]. The influence of religion
on these determinants are describe below.
Attitudes. Religion may affect behaviour by influencing the cognitive schemata. Research has
shown that individuals make reasoned choices that sustain their SC decisions and practices. Religion
may be one of the factors affecting such reasoning. Attitudes, a prominent construct to study this
cognitive schemata, have been systematically found a significant predictor of intention, which in
turn affects behaviour [75]. Religious values has been found to significantly influence attitudes,
either directly or indirectly through the mediation of environmental concern and natural environmental
orientation [49,76,77] or the individual’s beliefs and perceptions about nature [78].
Thus, in Muslims countries, having religious values- refers to values based on Islamic
scriptures such as Quran and Hadiths -was found to positively and significantly influence the
perception that humans are entrusted to steward the earth, which in turn nurtures pro-environmental
attitudes [49,76,77].
Beliefs of dominion and stewardship emerge as a key construct in understanding adoption of
SC among religious consumers. Drawing from White’s thesis, studies examining the links between
religion, belief of dominion (stewardship) and SC were conducted among Christians. Studies have
shown that these beliefs are not equally present among Christian affiliates; rather, the belief seems to
depend on the conservative or progressive interpretation of the scriptures. The dominion beliefs is held
by Protestant Christian to a greater extent, whereas the stewardship beliefs is shared by Catholics and
Orthodox to a lesser extent [79]. As expected, beliefs of dominion were associated with lesser adoption
of SC behaviours; similarly, beliefs of stewardship are significantly and positively correlated with
SC adoption. Specifically, these beliefs mediate the relationship between religiosity and behavioural
intention, with stewardship (dominion) exhibiting a positive (negative) influence on the willingness to
pay for sustainable alternatives of common consumer goods [60].
Environmental concern, or the evaluation of the environmental consequents of one’s behaviour [80],
is considered a consistent predictor of SC attitudes, intention and behaviour [9]. Several studies have
examined the relationship between religion and environmental concern. To illustrate, religiosity has
been found a moderator construct as it strengthens the intention to consume ecological products [81].
It is important to note that there are other constructs that have been found to weaken or strengthen
the relationship between religion and environmental concern. For example, political orientation was
found to be a powerful predictor of concern among religious people. More specifically, American
Christians with a conservative ideology displayed lower levels of environmental concern, compared to
those having a liberal political orientation [58]. This shows again the complex relationship between an
individual’s religion and political orientation.
Another two constructs were found to moderate the relationship between religion and
environmental concern in a multilevel analysis of data from 34 countries [50]. Life satisfaction [82,83]
and indulgence as a construct highly dependent on emotion [84] were found to be significant moderators
of the relationship between religiosity and environmental concern, measured at the country level. At low
levels of life satisfaction, non-religious people have low concern for the environment. This finding is
explained by contending that individuals with low life satisfaction are more focused on satisfying basic
needs, rather than higher level needs associated with environmental protection. However, religious
people show higher levels of environmental concern based on their religiosity, even when their most
Sustainability 2020, 12, 7901 9 of 21
basic needs are not satisfied [50]. Yet, these results should be interpreted with caution: this study did
not control for the influence of religion on life satisfaction which raises concerns of endogeneity.
Values. Several studies have found that self-transcendence (universalism and benevolence) values
positively affect adoption of SC [85,86], whilst self-enhancement values (related to the self-interest,
such as achievement and hedonism) negatively affects it. Similarly, it has been repeatedly found that
social-altruistic and biospheric value orientation are positively associated with pro-environmental
attitudes and behaviour [87,88]. The analysed studies show that the more individuals adhere to
self-transcendent values beyond their self-interest (self-enhancement values), the more likely they are
to adopt SC. Similarly, an altruistic value orientation, measured through attitude toward charitable
institutions, was found to predict sustainable purchase intention and religion, as an antecedent,
significantly and positively affect altruism, which in turn affect the intention to purchase green [72].
In contrast, hedonistic shopping values (an egoistic value orientation) is negatively associated with
the purchase of sustainable products; however religiosity was found to moderate this negative effect,
diminishing it [89].
The results shown above demonstrate that religion may influence SC by impinging on cognitive
processes. However, SC behaviour is guided by other factors than cognitive processes, in particular,
by automatic or habitual action. Religion may also affect habits. Indeed, for religious people of
Muslims countries green purchase intention depended less on attitudes as a predictor. In other words,
the purchases of green products not only involve cognitive judgments but also habitual decision
making and religious consumers choose sustainable alternatives first based on their habits (habits that
are already informed by their religious values), and not only by assessing the green information of
products on every purchase occasion [77].
Self-efficacy. The perceived ability to successfully complete an action [90] or the understanding
that one could make a difference on environmental and social injustices is an important variable
influencing SC behavior. In the sample, only one study examined the relationship between religion and
self-efficacy, finding that self-considered religious individuals have self-efficacy beliefs; these, in turn,
affect the intention to purchase products that contained a message of socio-ecological justice [91].
Social norms. Regarding the external behaviour factors, only limitedly studies have examined the
influence of religion on subjective or social norms [12]. Nonetheless, existing evidence seems to suggest
that religion may enable adoption of SC affecting the social norms; the importance that a particular
sustainable behavior, like recycling, has for a religious community was found to be the most important
predictor of recycling intention [69]. This is what literature called perceived peer endorsement or the
relevance of the reference group on the decision-making process [92].
Identity. Many studies have demonstrated the key role of identity-related constructs in explaining
adoption of SC [8]. Yet, none of the quantitative studies has examined the association between religion
and environmental identity. However, the fact that religion contributes to nurturing a form of green
identity is a fundamental conclusion of the analysed qualitative studies. Indeed, these studies have
examined the meaning-making practices of informants of their religious identity construct and its
influence on SC outcomes. Religious identity [93], strongly influences environmental beliefs and
practices of religious leaders [94] and religious environmentalists [95–97]. These studies show that
caring for the environment is a religious calling so that their belief in the creation as sacred and the
stewardship of the earth drives their everyday practices. Of important note, interviewees understand
their identity as holistic, as they involve existential and practical concerns, and include self-identity
and identity in context, in relation to others and they try to be coherent in all aspects of their identity
and its expression. In doing so, informants try to make gradual, serial and controlled changes on
their everyday actions to have a more intense and holistic SC [98]. In general, Christians and Muslims
consumers intend to avoid over-consumption and extravagance following their religious principles
like austerity and following their perceived association with socio-environmental injustices [96,97,99].
In summary, this review shows that religion influences internal determinants of SC such as
attitudes, values and self-efficacy, and external determinants, such as social norms. Also, religious
Sustainability 2020, 12, 7901 10 of 21
identity seems to be a central construct to explain SC practices but quantitative papers measuring this
association are missing.
5. Discussion
Regarding the morality and the identity facets of religion, there are missing studies examining the
mediating role of moral identity [118] in the relationship between religion and environmental behaviour.
This omission is relevant since moral identity was found to increase, for example, the willingness to
choose green products [119]. Moral identity is related to certain beliefs, attitudes, and behaviours,
particularly when that identity is highly self-important [120], as it is for religious people [121]. Also,
the role of virtues like prudence, simplicity, non-violence, compassion, humility, nurtured by all
religions [122] is other research avenue, because of their direct relationship with SC adoption [123,124].
Finally, the evidence shows that some types of religious beliefs, cognition and behaviour foster
self-regulation and self-control [125] and future studies should link it with SC outcomes such as
frugality and reduction of consumption, that necessarily implies the self-regulatory strength. These are
some of the many ways in which religion could foster SC at the individual level, and this systematic
review encourages scholars to advance research in these unexamined areas.
In summary, this research agenda encourage scholars to study other unexamined mediating
constructs -such as beliefs in after life, cleansing rituals and prayer, moral emotions, moral identity,
the role of virtues and self-restraint- that could enhance the understanding of the influence of religion
on SC.
5.3. Limitations
No study goes without limitations. As it has been the case of other systematic reviews, we
privileged Web of Science and Scopus as the source of studies; however, publications that were not
indexed in the chosen databases are not included in this study. The results of this systematic review
should be taken as a starting point for academic debate and research and not as closed conclusions.
Finally, researchers should be careful about constructs that may overlap with religion such as political
orientation; the evidence found for this systematic review is inconclusive in this regard and indicates
the need to analyse this in more depth to reach certain conclusions. Also, we did not carry out a quality
check of studies as a criterion to screen in/out studies. Indeed, some of the reported studies may raise
concerns of construct validity, endogeneity, and reverse causality. However, given the limited set of
studies we decided to include them all and discuss the methodological limitations as a reason for the
inconclusive findings.
6. Conclusions
This systematic review has shown there is evidence to suggest that individual’s religion may
play an important role in shaping SC. It integrates the existing studies by analyzing a potential causal
relationship between religion and SC. This study shows that religion at the individual level drives SC
behavior indirectly through its impact on other proven antecedents of SC, such as attitudes, values,
self-efficacy, social norms and identity. In addition to enrich the mediating factors whereby religion
shapes SC, the research agenda encourage scholars to disentangle the construct “religion” in its facets
(related to specific psychological processes) so to unveil the multiple ways in which religion may affect
SC. The development of a comprehensive understanding of the influence of religiosity on SC will
allow advancing research in this domain and suggestions are given in this respect. In sum, this paper
foregrounds the potential of religiosity to foster adoption of sustainable lifestyles, which, in turn,
benefits the whole society and the natural world.
Author Contributions: Conceptualization, A.O., C.V., and E.C.; methodology, A.O.; writing—original draft
preparation, A.O.; writing—review and editing, C.V., and E.C.; supervision C.V., and E.C. All authors have read
and agreed to the published version of the manuscript.
Funding: This research was funded by a pre-doctoral fellowship of “Fundación Tatiana Perez de Guzmán el Bueno”.
Conflicts of Interest: The authors declare no conflict of interest. The funders had no role in the design of the
study; in the collection, analyses, or interpretation of data; in the writing of the manuscript, or in the decision to
publish the results.
Sustainability 2020, 12, 7901 13 of 21
Appendix A
Reported
Section/Topic # Checklist Item
on Page #
TITLE
Title 1 Identify the report as a systematic review, meta-analysis, or both. 1
ABSTRACT
Provide a structured summary including, as applicable:
background; objectives; data sources; study eligibility criteria,
Structured summary 2 participants, and interventions; study appraisal and synthesis 1
methods; results; limitations; conclusions and implications of key
findings; systematic review registration number.
INTRODUCTION
Describe the rationale for the review in the context of what is
Rationale 3 1–4
already known.
Provide an explicit statement of questions being addressed with
Objectives 4 reference to participants, interventions, comparisons, outcomes, 2
and study design (PICOS).
METHODS
Indicate if a review protocol exists, if and where it can be accessed
Protocol and
5 (e.g., Web address), and, if available, provide registration -
registration
information including registration number.
Specify study characteristics (e.g., PICOS, length of follow-up)
Eligibility criteria 6 and report characteristics (e.g., years considered, language, 4
publication status) used as criteria for eligibility, giving rationale.
Describe all information sources (e.g., databases with dates of
Information sources 7 coverage, contact with study authors to identify additional 4
studies) in the search and date last searched.
Present full electronic search strategy for at least one database,
Search 8 4
including any limits used, such that it could be repeated.
State the process for selecting studies (i.e., screening, eligibility,
Study selection 9 included in systematic review, and, if applicable, included in 4,5
the meta-analysis).
Describe method of data extraction from reports (e.g., piloted
Data collection
10 forms, independently, in duplicate) and any processes for 5
process
obtaining and confirming data from investigators.
List and define all variables for which data were sought
Data items 11 (e.g., PICOS, funding sources) and any assumptions and 5
simplifications made.
Describe methods used for assessing risk of bias of individual
Risk of bias in studies (including specification of whether this was done at the
12 5
individual studies study or outcome level), and how this information is to be used in
any data synthesis.
State the principal summary measures (e.g., risk ratio, difference
Summary measures 13 5,6
in means).
Describe the methods of handling data and combining results of
Synthesis of results 14 studies, if done, including measures of consistency (e.g., I2 ) for 6
each meta-analysis.
Sustainability 2020, 12, 7901 14 of 21
Reported
Section/Topic # Checklist Item
on Page #
Specify any assessment of risk of bias that may affect the
Risk of bias
15 cumulative evidence (e.g., publication bias, selective reporting 5
across studies
within studies).
Describe methods of additional analyses (e.g., sensitivity or
Additional analyses 16 subgroup analyses, meta-regression), if done, indicating which -
were pre-specified.
RESULTS
Give numbers of studies screened, assessed for eligibility,
Study selection 17 and included in the review, with reasons for exclusions at each Figure 1
stage, ideally with a flow diagram.
For each study, present characteristics for which data were
Study characteristics 18 extracted (e.g., study size, PICOS, follow-up period) and provide 6
the citations.
Risk of bias Present data on risk of bias of each study and, if available,
19 6
within studies any outcome level assessment (see item 12).
For all outcomes considered (benefits or harms), present, for each
Results of study: (a) simple summary data for each intervention group
20 Appendix B
individual studies (b) effect estimates and confidence intervals, ideally with a
forest plot.
Present results of each meta-analysis done, including confidence
Synthesis of results 21 6–9
intervals and measures of consistency.
Risk of bias Present results of any assessment of risk of bias across studies
22 -
across studies (see Item 15).
Give results of additional analyses, if done (e.g., sensitivity or
Additional analysis 23 -
subgroup analyses, meta-regression (see Item 16).
DISCUSSION
Summarize the main findings including the strength of evidence
Summary of
24 for each main outcome; consider their relevance to key groups 9–12
evidence
(e.g., healthcare providers, users, and policy makers).
Discuss limitations at study and outcome level (e.g., risk of bias),
Limitations 25 and at review-level (e.g., incomplete retrieval of identified 12
research, reporting bias).
Provide a general interpretation of the results in the context of
Conclusions 26 12
other evidence, and implications for future research.
FUNDING
Describe sources of funding for the systematic review and other
Funding 27 support (e.g., supply of data); role of funders for the 12
systematic review.
Sustainability 2020, 12, 7901 15 of 21
Appendix B
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