These stakeholders can contribute to the production and uptake of scientific evidence through engagement in knowledge mobilization (KMb). KMb is the process by which evidence is made available through specific activities and tools8 and can bridge the knowledge to action gap that exists within children’s pain.9Pain impacts the life of every child; however, it remains undermanaged in both acute and chronic care contexts.10 Rather, concerted efforts that promote connections between researchers and other stakeholders are required to facilitate effective KMb and resource uptake.11 By engaging stakeholders in knowledge co-production and dissemination processes, access to evidence on pain management is made more attainable via existing connections to patients, caregivers, and their family members.9The reach and impact of KMb activities in Canadian health care settings is influenced by the inclusion of diverse stakeholders in knowledge production and KMb resource creation. The absence of engagement of non-researcher stakeholders in KMb efforts results in significant research waste, including the development of very costly yet unavailable and unused KMb tools, including eHealth tools.12 Needs assessments increase the suitability of implementation initiatives by eliciting stakeholder characteristics and developing an understanding of how best to engage them in implementation.14 Known barriers to accessing evidence and resources for children’s pain management include a lack of knowledge about pain management, a lack of importance placed on pain management, and insufficient time to locate and utilize resources.15–18 Needs regarding access to evidence include further education on pain management as well as the need for, and awareness of, evidence-based resources, for clinicians and patients, caregivers, and family members.20 These barriers and needs have been identified within samples including a range of stakeholder types, including knowledge users , researchers (including research trainees), and patients, caregivers, and family members; however, differences in the specific barriers and needs among these stakeholder types are not known. This missing perspective impedes effective dissemination and implementation of evidence-based practices to prevent and manage children’s pain. Understanding both shared and unique needs and barriers to accessing evidence would facilitate a tailored approach to disseminate and implement evidence in stakeholders’ own contexts.To promote the reach and impact of KMb initiatives in Canadian health care settings, it is critical to understand the relevant needs and barriers stakeholders face to promote effective engagement on KMb initiatives. Needs assessments identify these barriers and needs by eliciting perspectives directly from stakeholders.The objectives of this study were twofold. The first objective was to examine the needs of three diverse stakeholder groups  regarding the development and organization of resources, as well as to examine barriers and facilitators to accessing evidence-based information on children’s pain. The second objective was to explore differences within these specific needs, barriers, and facilitators among these three distinct groups.22 Data for needs assessments can be collected formally or informally, typically via surveys and interviews.22 This article aims to describe the methods used to gather the data with the intention of informing Solutions for Kids in Pain’s (SKIP) activities. The study was an online needs assessment survey developed and distributed by SKIP, a Networks of Centers of Excellence of Canada–funded knowledge mobilization network in Canada.23 SKIP’s mission is to improve children’s pain management by mobilizing evidence-based solutions through coordination and collaboration, with a vision of healthier Canadians through better pain management. This needs assessment survey was initially launched as part of SKIP’s funding application for the purpose of informing the development of their goals and activities in alignment with stakeholder needs. Advertising for survey participation was broad in nature, and study ads appealed to “any individual with an interest in children’s pain,” including knowledge producers , knowledge users , and end beneficiaries . The survey was developed in English and translated into French, representing both official languages of Canada. Respondents provided consent to participate online prior to beginning the survey. Though data collection via this needs assessment was initially exempt from research ethics board review, because data collection was for assessment and improvement purposes,24 the use of these data for research purposes was later submitted for review and approved by the IWK Health research ethics board (REB# 1027199). A widespread, snowball sampling approach to recruitment was taken, with recruitment conducted via social media platforms , e-mail, and listservs, and was open to Canadian and international respondents. For the purposes of the needs assessment, the term “pain” was used in an all-encompassing manner. SKIP’s focus is primarily on improving pain in children’s health institutions, and as such, “pain” in the current context referred to that which is commonly seen in health care settings, including both chronic and acute pain. The survey was available online from August 2018 to October 2020, with 93.1%  of responses received within the first 3 months of survey launch . The survey remained open via the SKIP website until October 2020, although no active recruitment efforts were made after 2018. All data collected until October 2020 were included in the study analyses.This study utilized both closed- and open-ended responses, where both types of data were integrated to provide a richer and more comprehensive understanding of the overall results. This study followed a traditional approach to needs assessment, an assessment that determines objectives to be addressed when establishing a project or study to promote tailoring of programs or recommendations.The online survey  consisted of 11 closed-ended and two open-ended questions regarding specific stakeholder needs for accessing evidence-based resources for children’s pain management, current evidence-based resources used, perceived accessibility of evidence-based resources, frequency and types of barriers experienced when accessing or implementing evidence-based resources, stakeholder type, and geographic location. Closed-ended questions consisted of Likert-scale and multiple-choice responses. Three closed-ended questions  also included an “other” response option, allowing respondents to elaborate with a free-text response. Respondents were asked two open-ended questions. The first question gauged respondents’ interest in knowledge mobilization activities (in collaboration with SKIP) related to children’s pain. The second open-ended question asked respondents to share other comments or feedback regarding a KMb initiative for children’s pain. The survey was developed in partnership with two patient/caregiver/family member partners (I.J. and D.P.R.), who were involved in developing the survey and ensuring the clarity and relevance of questions. The survey was pretested prior to launch with approximately ten stakeholders across the groups.25 Second, the French language data accounted for a minority of total survey responses , with insufficient numbers and statistical power to consider meaningfully on their own.Data collected in French were translated into English, and all responses were analyzed together. This was deemed appropriate for two reasons. First, given that the survey questions were adopted into French , the presentation of information in each question was standardized and considered equal in comprehension and interpretation in both languages.Quantitative analyses were conducted to address both study objectives. To address objective 1, descriptive statistics were conducted to characterize general stakeholder needs, barriers, and accessibility of evidence-based resources. To address objective 2, a series of one-way analyses of variance were conducted to examine differences between the three stakeholder groups  in frequencies with which barriers are encountered when accessing evidence-based resources, as well as ratings of accessibility of evidence-based resources. Also related to objective 2, a series of chi-square tests was conducted to examine differences between stakeholder groups in terms of types of barriers encountered when accessing evidence-based resources as well as stakeholder needs to ensure uptake of evidence-based resources.26 The analysis was conducted with two coders (N.E.M. and O.P.) and followed standard content analysis procedures.27 Due to variability in the number of responses to each item from each stakeholder group, free-text data from all stakeholder groups were analyzed altogether. To compensate for the fact that all stakeholder open-ended data were collapsed for qualitative analyses, efforts were made to include examples from respondents within each stakeholder group within the results where appropriate. Both coders reviewed the responses to each of the five free-text response items to become familiar with the responses provided and used line-by-line coding for the first 25% of responses, categorizing responses into codes of like concepts using a qualitative data management software .28 Following initial coding, the coders met to discuss and refine the codes as necessary to ensure consistency in approach. Once the codebook had been refined, the first author (N.E.M.) coded the remaining responses and grouped the categories under higher-ordered headings, based on relationships between individual categories. These groupings were then abstracted into overall main categories that formulated a primary description of each topic. This process was carried out, as described, for each set of free-text responses. To ensure rigor in this analytic process, coders met frequently to discuss the codes and abstraction of the categories, an audit trail detailing analytic decisions was maintained, and quotes that illustrated the interpretations made from the abstraction analytic process were included.The open-ended qualitative data were analyzed to address the first study objective using conventional content analysis, an approach typically utilized to explore a concept of which little is known.29 The results were integrated by first reporting the quantitative statistical analyses, followed by the related qualitative findings, to facilitate comparison. A comment regarding whether the qualitative results converged with those of the quantitative findings was included to facilitate this direct comparison. Further integration was then conducted .The integration of the quantitative and open-ended qualitative data occurred through comparing the results within each topic and determining how concepts complemented or expanded on each other, following the steps outlined by Creswell and Plano Clark.n = 442), followed by patients/caregivers/family members  and researchers . Stakeholders were predominantly from Canada , with 16.5% of responses from international respondents (n = 117). See A total of 711 stakeholders completed the survey, with 31 stakeholders (4.4%) responding in French. Survey respondents primarily identified as knowledge users  and pamphlets .Educational materials were the most commonly used resource among all respondents  and policies (see n = 45), with no significant differences across stakeholder type. There were also no significant differences between stakeholders on use of apps, videos, or arts-based tools .Webinars were the least commonly used resource collectively  training opportunities .Respondents shared some of the evidence-based resources for children’s pain they had used in response to the open-ended question. Information included here aligned with those categories endorsed in the quantitative data and provided specific examples of the types of resources used. Six subcategories of resource types were generated from this analysis , including (1) electronic resources intended for patients/caregivers/family members , (2) literature intended for patients/caregivers/family members , (3) knowledge user resources , (4) clinical tools , (5) knowledge mobilization initiatives,resources were not accessible; 10 = resources are completely accessible).Across all stakeholders, the mean rating of accessibility of resources was 4.80 (SD = 1.96), indicating moderate accessibility of evidence-based resources (0 = F(2) = 5.53, p = 0.004. Specifically, researchers found resources to be significantly less accessible than knowledge users . Patients/caregivers/family members also found resources to be significantly less accessible than knowledge users .Stakeholders significantly differed in their perceptions of the accessibility of evidence-based resources, barriers are never experienced; 10 = barriers are experienced all the time). Across all stakeholders, the mean frequency of barriers was 6.10 (SD = 1.93), indicating that stakeholders encounter barriers a moderate amount of the time when attempting to access or implement evidence-based resources. A lack of knowledge about children’s pain was the most common barrier reported among all stakeholders , researchers , or patients/caregivers/family members  in reported barriers to accessing or implementing evidence-based resources, F(2) = 0.54, p = 0.583 (see There were no significant differences between knowledge users (.583 see .n = 138) and researchers  and the second most common for knowledge users ; however, stakeholders did not significantly differ on this barrier  and found this to be significantly more problematic than patients/caregivers/family members (see n = 198). Patients/caregivers/family members identified competing health-related priorities as a greater barrier to evidence-based resources relative to knowledge users and researchers.Knowledge users identified insufficient resources as the most common barrier to accessing or implementing evidence , including (1) challenges locating and accessing relevant information and (2) lack of knowledge and support for accessing and implementing evidence-based resources.challenges locating and accessing relevant information, respondents described a lack of knowledge of relevant resources and restricted access to resources, such as paid access publications. Respondents also described a lack of materials as a barrier for specific patient groups, health conditions, or non-English speakers, thus limiting the evidence available and its uptake. In the second subcategory, lack of knowledge and support for accessing and implementing evidence-based resources, respondents described a lack of both administrative and clinical leadership as a barrier to the implementation of evidence in clinical practice. This was further complicated by institutional policies related to implementation of evidence, such as paperwork and limitations on clinical practice due to lack of resources available to support implementation . Caregivers also described lacking knowledge of their rights to pain management, further complicating their ability to access and implement pain management resources. These access-related challenges converged with those reported in the quantitative data, in terms of the types of challenges confronted, and identify additional complications encountered.In the first subcategory, n = 370). Stakeholders identified a significant need for large-scale networks, such as SKIP, to aid in addressing these needs .Stakeholders identified a range of needs to ensure increased use of evidence-based resources. Tools for health professionals was the most frequently identified need among all respondents ; however, this need was not significantly greater than that of other stakeholders. Researchers also indicated a significantly greater need for synthesized knowledge in priority areas of children’s pain, as well as for consultation for implementation, relative to knowledge users and patients/caregivers/family members.Researchers most frequently indicated a need for centralized access to resources , including (1) supportive strategies for effective evidence-based practice implementation; (2) broader awareness of, and support for, pain management practices and implementation; and (3) partnerships to promote development of knowledge mobilization initiatives.supportive strategies for effective evidence-based practice implementation, respondents described that practical resources , as well as tailored supports for the given clinical environment stakeholders work in , were central to successful implementation. Training was also identified as key resource for health professionals to gain additional skills and for health trainees who are developing their practices around evidence-based pain management. In the second subcategory, broader awareness of, and support for, pain management practices and implementation, respondents described the necessity of a “culture shift,” where the value of evidence-based practice reflects in institutional policy. Increased public awareness of the importance of pain management, as well as knowledge of how to manage pain, was also cited as a key step toward promoting better implementation of evidence-based practices for children’s pain. In the third subcategory, partnerships to promote development of knowledge mobilization initiatives, respondents identified the importance of not only having diverse stakeholders contribute to developing resources for KMb but also having input from a range of stakeholders when creating implementation plans to add perspective relevant to each unique context where information may be utilized. These qualitative results converged with the quantitative data on specific stakeholder needs, further illustrating the need for strategies, support, and partnership opportunities to support implementation of the identified resources in each stakeholder group.In the first subcategory, Respondents described a range of interests in terms of contributing to resource development as well as disseminating evidence and resources. Three subcategories were generated to describe respondents’ feedback , including (1) dissemination and implementation activities, (2) generating knowledge and resources, and (3) sharing perspectives as a stakeholder.dissemination and implementation activities, respondents not only indicated interest in sharing resources within their own clinics and networks but also expressed interest in being the recipients of dissemination activities, such as trainings and gaining access to resources with consolidated evidence or information repositories. In the second subcategory, generating knowledge and resources, many respondents saw value in being able to partake in research activities, not only as investigators but as respondents as well. Other respondents expressed a desire to assist with creating resources, including those that could be made available in various languages. In the third subcategory, sharing perspectives as astakeholder, respondents specifically discussed their interest in bringing their unique perspective as a stakeholder, as either a researcher, knowledge user, or patient/caregiver/family member, to engage in the knowledge co-production and/or evidence dissemination process. These qualitative results converged with the quantitative data presented by providing additional data on means by which stakeholders would like to be engaged to address the need for resources for specific stakeholder groups via KMb activities.In the first subcategory, Respondents primarily described additional needs to support the management of children’s pain clinically, and they also identified pathways and partnership opportunities to support the goal of improved pain management through accessibility of evidence. Three subcategories were generated to describe respondents’ feedback , including (1) children’s pain should be recognized and treated seriously, (2) the need for partnership to advance pain management efforts, and (3) development of further knowledge and resources for children’s pain.children’s pain should be recognized and treated seriously, respondents stated the importance of having children’s pain management as a priority for clinical care and stated that SKIP as a network was a critical initiative to take meaningful steps to shift the focus onto uptake of evidence to promote pain management. In the second subcategory, the need for partnership to advance pain management efforts, partnerships between diverse stakeholders, as well as interdisciplinary partnerships, were discussed as crucial to not only creating evidence-based resources but supporting their implementation, when partners learn from each other to advance the goals of KMb in children’s pain. In the third subcategory, development of further knowledge and resources for children’s pain, respondents not only raised the importance of having further research evidence to support implementation and subsequent pain management but also highlighted the need for these resources to be developed with a range of families in mind. This included respondents who speak languages other than English, those from underrepresented populations , and children with special needs. These data converged with the quantitative results, further highlighting the identified barrier of pain management as lacking priority in clinical practice, as well as the identified need for more tailored resources for stakeholders.In the first subcategory, In this survey of 711 stakeholders, the distinct needs of knowledge users , researchers (including research trainees), and patients, caregivers, and family members pertaining to evidence-based resources for children’s pain management were examined, as well as the barriers they face when trying to access these resources. Though stakeholders demonstrated similarities in the frequency and types of barriers faced, they differed significantly in their unmet needs to address these barriers and their preferred methods of accessing evidence. The qualitative results converged with the quantitative data, further highlighting specific needs and contexts in which barriers existed to accessing evidence-based resources for children’s pain management. These results ultimately inform how evidence may be best shared with stakeholders to improve the pain management of Canadian children.34 Researchers reported using evidence summaries significantly more than other stakeholders, which in a research context likely refers to published systematic reviews or meta-analyses. Researchers’ greater use of this particular type of evidence-based resource would facilitate their ability to remain up to date with a given field of literature, which is ever-changing.35 Finally, patients/caregivers/family members reported using social media and websites significantly more than other stakeholders. This finding is consistent with other research that shows patients and caregivers frequently use various social media platforms  to develop knowledge on medical conditions and general pediatric health.37 Knowledge of the modalities preferred by each stakeholder type can inform development of specific types of evidence-based tools designed to reach specific stakeholder audiences. It is clear that all stakeholders desire comprehensive yet concise, reliable data on which they can base their decisions for research and management of children’s pain management in Canadian health care settings. Finally, it should be acknowledged that the vast majority of these data was collected prior to the COVID-19 pandemic. As such, preferences for and reliance on online resources such as webinars may have changed and should be considered when developing educational resources.Stakeholders significantly differed in terms of the types of evidence-based resources for children’s pain management they typically used. Overall, their preferences aligned with resource types already designed with their context in mind. For example, knowledge users used point-of-care tools significantly more than other stakeholders. Research shows that point-of-care tools are uniquely equipped to meet the information needs of knowledge users such as health professionals, given that such tools provide immediate access to evidence-based information for decision making.39 It is worth considering, however, that this finding may be influenced by the type of resources knowledge users have access to, where articles and resources behind paywalls are generally more accessible to health professionals relative to patients/caregivers/family members; that is, knowledge users may inherently have greater means to accessing resources, as well as a wider variety of resources available, relative to other stakeholder groups. Though researchers and trainees may also have greater access to publications behind paywalls, they reportedly lack familiarity with other evidence-based resources, such as clinical practice guidelines and other clinical resources, especially compared to knowledge users such as health professionals.39 It may be, however, that researchers seek evidence-based resources less frequently than other stakeholder groups, given that they do not typically implement evidence in clinical practice themselves and are less familiar with how to access them. This gives credence to the importance of KMb networks, such as SKIP, because they can offer support to close these competency and resource gaps. There is also evidence that when youth look online for information on their health and well-being, they encounter a great deal of misinformation or information that is not evidence based.40 This suggests that when patients/caregivers/family members are looking for their preferred evidence-based resources, identified earlier as social media or websites, they may struggle to identify or access high-quality information. Though each individual stakeholder group may differ in the degree to which they find resources accessible, the present findings shed light on a larger issue of accessibility of evidence for all stakeholders, where evidence may not be available where stakeholders traditionally seek information or the information available is not evidence based. Therefore, it is critical that evidence be made available in the locations where diverse stakeholders are known to seek it out, in an effort to engage in more meaningful dissemination.In terms of access to evidence-based resources, stakeholders significantly differed in their perceived accessibility of resources, where researchers and patients/caregivers/family members reported resources as significantly less accessible than knowledge users. This finding is consistent with other research that shows that knowledge users, such as health professionals, can reliably access evidence via online means and demonstrate a greater awareness of evidence-based resources relative to other stakeholders.41 Generating awareness and urgency about the importance of children’s pain and developing and disseminating resources serve as a foundation to dispelling misbeliefs and ultimately making evidence-based resources more accessible in Canada. Clearly communicating these key messages to one’s target audience is critical to effective KMb and drawing stakeholders’ attention to evidence-based resources.42All stakeholders reported that, on average, they encountered barriers with moderate frequency. All stakeholders reported that a lack of knowledge about children’s pain was a significant barrier, as were attitudes toward prioritizing pain. This finding aligns with existing literature that has identified poor attitudes and knowledge, such as inaccurate beliefs that children forget pain, infrequent assessment of children’s pain, and not taking children’s reports of pain seriously, as being detrimental to the uptake of evidence for children’s pain management among knowledge users such as health professionals and caregivers/family members.43 When information is delivered in a way that addresses stakeholders’ unique needs, the information can be more easily understood and implemented.43Though stakeholders largely agreed on the barriers encountered when accessing evidence-based resources on children’s pain, they significantly differed when it came to their needs. Knowledge users and patients/caregivers/family members identified a need for specific tools geared toward their respective stakeholder groups, whereas researchers identified a need for centralized access to resources and synthesized knowledge on children’s pain management. The finding that stakeholders have specific needs in terms of access to evidence-based resources aligns with other evidence that demonstrates that individuals require information specifically geared toward their individual needs.44 Therefore, not only do stakeholders express a preference to engage in partnership in the knowledge production and dissemination process but evidence also suggests this may lead to more effective uptake of evidence in the Canadian health landscape.In addition to these distinct needs in terms of resource types, stakeholders discussed the need to develop and gain support for implementing evidence-based practices. Specifically, stakeholders identified the need for more partnerships between diverse stakeholder groups for the development, dissemination, and implementation of KMb resources, where they could impart their knowledge and unique perspectives at various stages of the KMb process. The desire to be engaged with multiple stakeholders, including patient partners and interdisciplinary health professionals, is a critical component of the evidence uptake process, because research has identified a lack of stakeholder engagement to be a significant barrier to evidence uptake.46 Tailoring efforts should consider the most appropriate strategy for KMb as informed by the identified needs and barriers, potential adjustments of strategies given the stakeholder’s context, and consideration of resources required to facilitate the KMb activity,13 especially in the Canadian health care context. Furthermore, tailoring not only involves adapting the type of content communicated to the intended stakeholder audience but also involves attending to the language used  and where the resource is made available.47 When KMb resources are tailored to individuals’ needs, they are more apt to be effectively disseminated and used.48Though stakeholders identified common barriers to accessing evidence-based resources for children’s pain, in terms of both type and frequency, the needs that stakeholders reported to address these barriers differed significantly. It is recommended that resources be tailored for different stakeholder groups, not only in terms of evidence-based resources themselves but also in terms of how and where these resources are disseminated. Tailoring is a method of adapting processes and supports based on stakeholder needs, as determined through stakeholder engagement in evidence review and uptake.Based on the present findings, it is recommended that tailoring also extend to evidence-based resource development for diverse Canadian audiences. These include stakeholders who are non–English speaking as well as any adaptations that are needed to ensure equitable and inclusive to reach marginalized or racialized populations or population groups based on culture, ethnicity, or other factors. Based on the present findings, there is a need for evidence-based resources on pain management for diverse audiences that have been developed in different languages , for underrepresented populations , and for children who are neurodevelopmentally diverse . Tailoring resources to meet these unique needs is especially important given that these groups may have specific needs or questions when it comes to knowledge around children’s pain management.11 Stakeholders in the present study clearly identified a desire to be engaged in KMb activities through sharing perspectives in the knowledge production and resource creation stages, partnering with diverse stakeholders during this process, and participating in disseminating such resources within their own networks. Engaging stakeholders, including various types of knowledge users  and patients/caregivers/family members, at various stages of KMb activities is a key recommendation because it can facilitate the tailoring process by sharing specific needs, preferences, and critical perspectives on how information can be best presented as well as implemented in a Canadian context.49 In turn, partnership between stakeholders at various points in the KMb process can serve to support efforts to address the specific needs and barriers of stakeholders. To engage stakeholders in partnerships within KMb processes is to work in line with the integrated knowledge translation approach, where all relevant stakeholders are engaged in the knowledge co-creation process such that relevant needs are integrated within the broader knowledge production, dissemination, and implementation phases.13 Integrated knowledge translation therefore creates another opportunity to address the needs identified in this study, including that of partnership, where stakeholders would be embedded in KMb projects at various stages. Establishing these engagement and partnership opportunities can be facilitated through networks such as SKIP, which can form bridges between stakeholders who can partner together to ultimately create more meaningful and relevant KMb outcomes,50 such as evidence and resources.The findings of the present study extended beyond simply identifying stakeholder needs by shedding light on stakeholders’ desired involvement in this process. In order to address this desire, it is recommended that stakeholders be engaged in partnership during the development of such resources. Partnership with stakeholders will support resource development and dissemination by shedding light on preferred modalities of information delivery within the given stakeholder group but can also promote greater uptake and influence of the resources that are subsequently developed.47 In the present study, stakeholders reported that beyond simply having access to resources specific to their needs and preferred modalities, it was important to have supports available for using the evidence for pain management in practice. Therefore, to support use of evidence in clinical settings, it is recommended that stakeholders be provided with practical recommendations for implementing evidence, as well as educational resources, training opportunities, and other practical resources, such as staff responsible for evidence uptake in clinical settings. When the intention of evidence is clearly communicated and justified, sufficient training and information are provided, and there is adequate team support in the clinical environment where the evidence will be used, evidence is more likely to be successfully integrated as a part of standard pain management for children.52 Therefore, this information should accompany evidence-based resources, such that stakeholders are fully supported in their efforts in both accessing and utilizing evidence. SKIP is committed to supporting implementation efforts, communicated via their vision of healthier Canadians through better pain management for children, and long-term outcomes of improved children's pain management in Canadian health institutions (see kidsinpain.ca). SKIP’s activities to accomplish these goals is driven by engagement in a range of evidence-based dissemination and implementation strategies, such as those summarized by Tutelman and colleagues53 and Chambers.9 This commitment is underpinned by the current study findings, reinforcing the importance of an organization such as SKIP to support the identified needs for implementation to improve outcomes within children’s pain management.Implementation activities take a step beyond dissemination and represent the stage at which evidence is ultimately adopted within a setting, such as a hospital or clinic.53 Therefore, conclusions around the role of contextual factors related to barriers or needs cannot be accounted for. Related, pain was not defined as part of the study introduction and, as such, respondents likely drew on diverse experiences with pain in their clinical and personal experiences . As such, given the broad sample of respondents described in this study, there may be nuances in stakeholder needs, barriers, and facilitators within specific pain services that are not captured by the current study results. Furthermore, because of the nature of this needs assessment, minimal demographic data were collected from respondents, thus limiting the examination of these results in the context of various demographic variables . Future research should explore demographic factors as well as the contexts in which stakeholders access and use evidence to enrich understanding of how they can be best supported in these unique contexts. This study did not explore perspectives from policymakers or other decision makers. Given the distinct roles of these stakeholders relative to those included in this study, the generalizability of these findings is limited in terms of how they relate to these other audiences. The present study is limited by factors related to data collection. Recruitment primarily occurred via social media, which may have introduced bias into the present findings, given that respondents may have been savvier with online connectedness and knowledge sharing, which could relate to the ease with which they access evidence digitally. Furthermore, the survey was useful in the current study context and efforts were made to increase survey construct and face validity by including stakeholders in survey development to ensure clarity of questions and comprehensiveness of the survey; however, the survey was not formally psychometrically validated. It is noted that psychometric validation of needs assessment surveys is uncommon within the needs assessment literature55; however, this does limit the use of the survey in contexts outside of that investigated in this study. Finally, this sample was primarily made up of Canadian respondents. Given the structure of the Canadian health care system, especially relative to other countries without universal health care, the concerns and needs expressed by those in the present sample may not entirely generalize to stakeholders that interact with a different style of health care system. Furthermore, access to resources via health care institutions or even via media  may differ among countries, thus potentially limiting the generalizability of the current findings to international audiences in terms of preferred methods of accessing evidence. Future research should explore the barriers and needs of stakeholders in diverse social and geographical contexts to further our understanding of common and unique needs of stakeholders when it comes to access to resources for children’s pain management.This study is the first of its kind to examine barriers and needs for accessing evidence-based resources for children’s pain management and is strengthened by its large sample size and integration of closed- and open-ended data. This approach facilitated identification of the specific needs and barriers experienced by stakeholders and facilitated an understanding of how they believed these needs could be most effectively met in detail to provide recommendations to researchers in future KMb endeavors. This study was not without its limitations. Firstly, the sample distribution comprised predominantly knowledge users, which means the needs, barriers, and accessibility issues reported by knowledge users may have skewed the findings and overshadowed those expressed by patients/families/caregivers and researchers. Further to this, the knowledge user stakeholder group was defined as potentially including a variety of professionals, including health professionals, administrators, policymakers, and educators. As such, results may not be directly relatable to each type of professional within this group, and future research is needed to account for the unique needs of the stakeholders that exist within this broader category, including policymakers and other decision makers. Related, trainees were also captured within the researcher stakeholder group; however, there was potential heterogeneity among the trainees represented in the current sample, such as undergraduate, graduate, or postdoctoral trainees; fellows; and residents. Furthermore, career stage was not considered within those who identified as a career researcher and, as such, researchers at various career stages may have been represented within the sample. The needs of these diverse trainees and researchers may be distinct; therefore, future research should consider exploring the unique needs of the specific stakeholders within these groups so they are appropriately supported in KMb activities. In addition, the data collected via this survey did not explore the specific contexts in which stakeholders were attempting to access or utilize evidence-based resources for children’s pain. The context in which evidence is implemented can influence outcomes by way of factors including finances, support, and leadership.Stakeholders face similar barriers to accessing evidence-based resources on children’s pain management but report diverse needs and desired approaches to access this information and facilitate its implementation. Identification of these common factors and differences is critical to inform how evidence-based resources can be tailored to present information to various stakeholder groups in the most effective method possible. Furthermore, stakeholders identify a clear need for guidance on how evidence can be implemented in their specific contexts. Engaging stakeholders in knowledge production, resource development, and dissemination is a clear desire to ensure the resources created best serve their needs and can be easily accessed.Click here for additional data file.Click here for additional data file.


The rapid development of online shopping has contributed to marketing strategy. Social presence plays an important role in the field of marketing. Therefore, this paper studies the influence of social presence on online impulse buying. The key marketing strategy is that consumers make impulsive buying behavior in online shopping. This paper proposes a research scheme for an impulsive buying sharing model based on user features and an article studied before which has some factors presented. The model is evaluated on a data analysis based on SPSS24.0 and AMOS23.0. The results show that the main factors such as interactivity, vividness, and media richness, all have positive effects on social presence. Therefore, in the variable relationship, social presence has a direct impact on impulsive buying behavior. This result has a theory contribution on the marketing theory model which also has an important practice significance in marketing strategy for enterprises. With the development of online shopping, consumers' shopping methods can be divided into rational purchases and impulsive purchases. Therefore, it is necessary to study impulsive shopping behavior for which social presence is the key factor in online shopping. Gunawarden  defined Rook and Fisher  defined Piron  defined The idea of social presence originated from the two concepts of directness and intimacy, which were involved in the study of interpersonal interaction in the field of social psychology and mainly focus on remote exchange media by Cui et al. . Gefen aIn the online broadcasting room, consumers can see the physical display of sellers on the other side of the communication port in real time with the help of the live broadcasting platform, and they can communicate with the sellers through text. Generally, the live broadcast interface is attached to a payment link through which one can place an order directly and these transactions can be concluded directly under the guidance of the seller. This means that given the real-time physical display and the seller's hard sales guidance, consumers can make consumption decisions quickly.Interactivity has been defined in many ways. For example, Blattberg and Deighton  defined Vividness was the degree of connected objects that combine the sensory experience of actual objects with the nonsensory experience of hallucinations . In the Both interactivity and vividness significantly affected social presence and indirectly affect participation. Engagement has the most significant effect on all advertising effectiveness indicators, i.e., greater than the initial hypothesis of this study. The key role of engagement found the process of buying consumers may interact with new media; it is a more conservative emotional process that is more consistent with the information processing view than initially thought, thereby supporting the usage and satisfaction paradigm . If, froMedia richness, as proposed by Daft and Lengel , refers Therefore, we summarize the existing literature on social presence and e-commerce, combined with the interactive characteristics of live broadcasting platforms; this study argued that interactivity, vividness, and media richness mainly affect social presence. Interactivity was considered to be a kind of environment which users can participate in and make adjustments to from time to time .Moderating variables can be qualitative  or quantitative , and they affect the direction (positive or negative) and strength of the relationship between the variable and the number of arguments. The research history and application of impulsive buying traits as a moderating variable will be reviewed in the following. The moderating effect of impulsive buying tendency.Wu and Guo  took indThe existing literature points out that interactivity is a key factor affecting social presence by Hassanein and Head . ResearcH1: Interactivity has a positive impact on social presence in online shopping.Vividness can improve depth through richness, which refers to the width and breadth of the quality of information perceived by media users and to the sensory dimension that a communication medium can provide . The moH2: Vividness has a positive impact on social presence in online shopping.Parker et al.  put forwH3: Media richness has a positive impact on social presence in online shopping.Waller and Bachmann  point ouH4: Social presence has a positive impact on online impulsive buying behavior.The data collection for the current study was greatly supported by an electronic questionnaire, which was divided into two stages. One stage was based on the principle of judgment sampling surveys and was presented in the form of a questionnaire that was sent through WeChat, electronic mail, and other social media platforms, as well as forwarded for use through the network broadcast platform, and was mainly distributed in Guangdong, Macau, Beijing, Shandong, Northeast China, and other places for volunteers to fill out and submit. The questionnaire used in this study was mainly distributed through Internet research, and the survey subjects were people who had impulsively consumed goods in an online live broadcast room. The surveyed was completed mainly by social people and was supplemented by graduate and undergraduate students.Initially, 340 self-questionnaires were distributed during a year of field visits and survey collection. After deleting incomplete and mismatched questionnaires, 319 valid questionnaires (93.8%) were retained and ultimately constituted the research sample. Among the respondents, 63.23% were female and 36.76% were male. Regarding the educational level, 3.82% of the respondents had finished middle school or below, 8.24% had finished junior college, 44.41% had finished a bachelor's degree, 31.47% held a master's degree, and 12.06% held a doctoral degree. The ages of the online shopping consumers were as follows: 3.82% were under the age of 20; 37.06% were between 21 and 30; 37.35% were between 31 and 40; 13.53% were between 41 and 50; and 8.23% were above 50. The annual incomes of the respondents were as follows: 21.76% had an annual income below RMB 150,000 ; 24.12% had an annual income between RMB 160,000 and 300,000; 20.59% had an annual income between RMB 310,000 and 450,000; 10.59% had an annual income between RMB 460,000 and 600,000; and 22.94% had an annual income above RMB 610,000.All the scales used in this study are mature scales that have been used in international journals which have good reliability and validity. Descriptive statistics is conducted for the items located in the questionnaire survey of this study, mainly including average values and the standard differences of the variables, and the data distribution states of the measurement items were judged according to each value.First, the reliability of each variable dimension measurement index was determined. Reliability mainly tests the consistency and reliability of variables in a study for each measurement item to ensure the validity of the model fitting degree. Nunnally (1998) believed that an alpha coefficient greater than 0.9 indicates the best reliability, a value between 0.7 and 0.9 indicates good reliability, a value between 0.35 and 0.7 indicates medium reliability, and a value less than 0.35 indicates low reliability. As Devellis (1991) suggested, a Cronbach's alpha value greater than 0.7 indicates that the reliability is satisfactory. Therefore, reliability is a method by which to measure internal consistency. The higher the coefficient is, the higher the consistency and reliability of the data are.As seen from As seen from As seen from As seen from Structural equation modeling (SEM) is a confirmatory analysis method that is used for multivariate statistical analysis. Through the reliability and validity testing of the questionnaire, it was concluded that all the scales used in this study have good reliability and validity. Furthermore, AMOS 23.0 was used for hypothesis testing to verify whether the model fitting degree and path were significant and to test whether the independent variable had a significant impact on the dependent variable. AMOS uses the chi-square value as the fitting test result, and the fitting degree usually uses CMIN/DF, GFI, RMR RMSEA, AGFI, NFI, CFI and IFI as indicators.p values between the interactivity, vividness, and MR and SP variables were all less than 0.05. Interactivity had a significant positive effect on social presence , and vividness had a significant positive effect on social presence . Finally, media richness has a significant positive impact on social presence , and the hypothesis is valid, which indicated that these three variables all had positive and significant effects on SP; thus, our hypothesis was valid. Social presence has a significant positive impact on impulsive buying behavior  and the hypothesis is true. The hypothesis holds that price promotion has a significant positive effect on impulse buying behavior .As seen from As seen from Since the goodness of a chi-square test depends on the sample size, the goodness-of-fit index (GFI) does not depend on sample size for easy measurement; rather, the goodness-of-fit index can measure the degree to which the covariance matrix predicts the S matrix. When the GFI is 1, it is an ideal model; however, during modeling and analysis, it is generally believed that if the GFI value is greater than 0.9, the model results are ideal. In this study, the GFI was 0.893, which is close to 0.9. Thus, it can be judged that the model fits well.The AGFI is similar to the GFI in that the closer it is to 1, the better the fitting effect is. Generally, the value of the AGFI is required to be at least greater than 0.85; however, for the same model, the AGFI must not be greater than the GFI. In this study, the AGFI was 0.877, which is greater than 0.85, and it was less than the GFI; thus, the model fitting effect was good.Among the numerous fitting indicates, the probability of making type I and type II errors is small, which presents a reasonable fitting index. The closer the fitting index is to 0, the better the fitting effect of the model. In this study, the root mean square error value was 0.034, which is lower than 0.1; this indicates that the model had a good fitting effect.AIC is often used to evaluate general statistical models. The better the model fits, the smaller the AIC value will be; however, the value is affected by the number of samples and parameters in the model. A large number of samples and parameters will easily cause a bad model to be mistaken for a good one.For SRMR, some models are not greatly affected by N, while others are greatly affected by N. Hu and Bentler believed that when SRMR < 0.8, the model fitting effect is better. In this paper, the SRMR value was 0.036, which is less than 0.8. Therefore, it can be considered that the overall fitting effect of the model was good.In this paper, the structural equation model tested by data collection and investigation, and the correlations between them were discussed. Through research methods such as theoretical deduction, model, and statistical tests, which were used to determine the main characteristics of compulsive purchase behavior in regard to online shopping variables, the main variables affecting social presence, impulsive purchase, and consumer personality tendencies, with core variables focusing on the relation between social presence and action, formed the following four conclusions.First, the literature review shows that with the rapid development of the Internet, online shopping is more convenient than offline shopping for many platform enterprises. At present, platform enterprises are still developing operation plans for offline brands; therefore, it is very important for enterprises to study the impulsive buying behavior of consumers in relation to online shopping.Second, the influence of interactivity, vividness, and media richness on social presence and the corresponding influence path have been clarified. The empirical results show that interactivity, vividness, and media richness, all have positive effects on social presence. Therefore, in online shopping, the atmosphere felt by consumers in the live broadcast room and the characteristics presented in the live broadcast room must meet the premises of interaction, vividness, and media richness in order to have a positive impact on consumers' impulse buying behavior.Third, the current study proves that social presence has a direct influence on impulsive buying behavior through the variable relationship. This outcome shows that in the context of Internet shopping, the sense of social presence is a core variable, and consumers are prone to impulsive buying behavior when they perceive that they are physically present, i.e., if they feel that they are really in the live broadcast room. Social presence plays an important role, and the user's experience of social presence directly affects his or her degree of impulse consumption. Therefore, the challenge of how to make consumers have a sense of social presence is a core issue when constructing online live shopping experiences.Fourth, the current study verifies the positive moderating effect of consumers' personal trait of having an impulse buying tendency on social presence and impulse buying behavior. Among these factors, the higher the impulse buying tendency is, the stronger the positive impact of social presence on impulse buying behavior is. The research study of foreign scholars has also confirmed that impulse buying tendencies have a positive response on impulse buying behavior.An effective marketing module is proposed in this paper, which is based on the SOR theory module and predecessors research, aiming at the problem of online impulsive buying. In order to verify, the module is added to the feature extraction network. Experiments were carried out on the data analysis, the module gets the best performance in the data analysis index GFI gets 0.903, and the results show that the module proposed in this paper can improve the hypothesis.The innovation of this paper are two theoretical contributions. First, the concept of social presence comes from the field of psychology. The concept has attracted attention from brand management, marketing, and communication studies. Second, the academic contributions of this study mainly include the following two aspects: the variables affect the social presence of platforms and establishing the relevant of impulsive buying behaviors. Previous research on social presence has mainly focused on artificial intelligence, online education, and VR, which has filled the gap in brand affection research on live broadcast platforms and provided new ideas for follow-up research on brand affection in the Internet content.For the factors related to impulsive buying behavior in online shopping, this paper only focuses on the influence of the three leading variables of interactivity, vividness, and media richness; it does not consider the mediating or moderating effects of other variables in the influencing path. Undeniably, the relevant factors affecting impulsive buying behavior in online shopping are complex and diverse; there is even a model of other unknown factors that influence impulsive buying behavior in online shopping in the Internet context. It is hoped that further research can further explore more potential influencing factors, intermediary variables, and moderating variables in order to supplement and improve the results of this study and make further contributions to the study of online shopping platforms. There is a lack of discussion on social presence in the field of live broadcasting. Social presence is a multidimensional concept, and the degree of its strength differs in different product categories or industries. Therefore, the influence of various dimensions of social currency on brand affection can be studied on this basis in the future. Therefore, research on consumers' impulsive buying behavior in relation to online shopping requires more in-depth and comprehensive discussion.


Natural climate solutions (NCS)—actions to conserve, restore, and modify natural and modified ecosystems to increase carbon storage or avoid greenhouse gas (GHG) emissions—are increasingly regarded as important pathways for climate change mitigation, while contributing to our global conservation efforts, overall planetary resilience, and sustainable development goals. Recently, projections posit that terrestrial-based NCS can potentially capture or avoid the emission of at least 11 Gt (gigatons) of carbon dioxide equivalent a year, or roughly encompassing one third of the emissions reductions needed to meet the Paris Climate Agreement goals by 2030. NCS interventions also purport to provide co-benefits such as improved productivity and livelihoods from sustainable natural resource management, protection of locally and culturally important natural areas, and downstream climate adaptation benefits. Attention on implementing NCS to address climate change across global and national agendas has grown—however, clear understanding of which types of NCS interventions have undergone substantial study versus those that require additional evidence is still lacking. This study aims to conduct a systematic map to collate and describe the current state, distribution, and methods used for evidence on the links between NCS interventions and climate change mitigation outcomes within tropical and sub-tropical terrestrial ecosystems. Results of this study can be used to inform program and policy design and highlight critical knowledge gaps where future evaluation, research, and syntheses are needed.To develop this systematic map, we will search two bibliographic databases (including 11 indices) and 67 organization websites, backward citation chase from 39 existing evidence syntheses, and solicit information from key informants. All searches will be conducted in English and encompass subtropical and tropical terrestrial ecosystems . Search results will be screened at title and abstract, and full text levels, recording both the number of excluded articles and reasons for exclusion. Key meta-data from included articles will be coded and reported in a narrative review that will summarize trends in the evidence base, assess gaps in knowledge, and provide insights for policy, practice, and research. The data from this systematic map will be made open access.The online version contains supplementary material available at 10.1186/s13750-022-00268-w. Addressing the drivers of climate change and mitigating the impacts humanity already confronts is at the top of global priorities. There is widespread concern and increased ambition to prevent global warming from reaching or exceeding 2 °C and meet the Paris Climate Agreement goals. Amongst these calls for action, there is a major focus on improving stewardship of terrestrial ecosystems thereby strengthening the role these systems can play in achieving climate change mitigation outcomes. Those activities that fall within the agricultural, forestry, and other land use (AFOLU) sector are estimated to contribute about one-fifth of global greenhouse gas (GHG) net emissions through degradation and conversion of natural ecosystems (e.g. forest and grasslands) and agricultural production . SimultaIn the wake of the global COVID-19 pandemic and increasing incidences of climate change-related floods, extreme heat, and storms —global a2, CH4, CO2) in all economic sectors, and increased carbon storage and sequestration of above- and below-ground carbon. Within the larger global efforts needed to achieve climate change mitigation, NCS could represent at least a third of the total cost-effective mitigation potential, with the highest potential in tropical countries ) analyses , 46 on t2 through photosynthesis and carbon enters the soil through the growth and death of roots as well as the deposition of leaf litter and other aboveground organic material [2 is released from microbial respiration (or ‘soil respiration’). Carbon can also be released as emissions to the atmosphere through soil disturbance  [Soil organic matter plays an essential role in the global carbon cycle as well as providing key ecosystem services such as retention of water and nutrients which in turn support plant productivity . Soil ormaterial . Carbon d LULCC) .only examine outcomes belowground (e.g. soil organic carbon or belowground biomass) (see Relevant Outcomes below). As belowground mechanisms of carbon storage and sequestration are also important, we will also code articles that measure impacts belowground in addition to the outcomes two listed above, thereby capturing the subset of articles that provide more comprehensive assessments (both above- and belowground outcomes).This study focuses on the impacts at the first point where carbon is fixed into a terrestrial ecosystem (i.e. through aboveground biomass) and the last point where it exits (as emissions)—thus capturing the primary ways in which carbon storage, sequestration, and emissions are measured for tracking progress to climate change at scale. We focus on mitigation outcomes for emissions and carbon storage and/or sequestration within aboveground biomass in tropical and subtropical terrestrial ecosystems. While we recognize the significant contribution of storage and sequestration in soil carbon, given the time and resources available for this review, we are not including articles that The methodology for building this systematic map includes three phases: (1) establishing key search terms to capture the concepts identified in the conceptual framework; (2) developing the scope and strategy of the search and inclusion/exclusion criteria; and (3) developing the scope and extent of a coding framework to extract relevant information to characterize the evidence base.A comprehensive search will be undertaken to best capture an unbiased representation of existing literature related to our research question.Given available resources for this systematic map, we only search in English. We recognize that this may bias our systematic map as there may potentially be relevant literature in other languages . TherefoWe compiled a set of search terms relevant to different components of the research question .ANDIntervention(restoration OR reforestation OR afforestation OR replanting OR rehabilitation OR enrichment OR "tree islands") OR  NEAR/3 (felling OR cutting OR harvest*)) OR "grazing management" OR "active management" OR "salvage logging" OR "reduced-impact logging" OR "alley cropping" OR "fire management" OR plantation OR "forest management" OR "manure management" OR ((crop OR cropland) NEAR/2 management) OR windbreaks OR thinning) OR ("protected area" OR "protected areas" OR ("Indigenous Peoples" OR "Indigenous communities" OR "Indigenous groups") OR "national park" OR "concession" OR "buffer zone" OR "sacred groves" OR "sacred forests" OR "sacred forest" OR "sacred grove" OR (protection NEAR/2 (forest OR landscape OR grassland))) OR .ANDOutcome("land use change" OR "land-use change" OR "land conversion" OR "forest conversion" OR "grassland conversion" OR deforestation OR "land cover" OR "forest cover" OR "vegetation cover" OR "habitat cover" OR "tree cover" OR (clearing NEAR/4 (forest OR land)) OR ((diversity OR composition OR recovery OR succession) NEAR/1 (tree OR forest)) OR ((biomass OR biomasses) NEAR/2 (tree OR shrub OR woody OR aboveground OR above-ground OR recovery OR living)) OR (degradation NEAR/2 (forest OR grassland)) OR ((climate OR carbon OR CO2 OR GHG OR "greenhouse gas") NEAR/3 mitigat*) OR ((carbon OR CO2) NEAR/2 ) OR (("greenhouse gas" OR GHG) NEAR/2 (emission OR avoid* OR reduc*)) OR aboveground OR above-ground).ANDOutcome adjacent.NOT.NOTTI = ("modelling" OR "modeling").We tested the comprehensiveness of the search string by testing it against a library of 30 relevant articles compiled by the review and stakeholder team and from backwards citation chasing , Environment Complete (EBSCO). Selection of these databases was based upon previous systematic evidence syntheses on related topics . We. WePubliTopical databases and organization searches Targeted searches of specialist websites and databases will be conducted, in particular, of established online repositories of impact evaluations, project and program evaluations, and systematic evidence syntheses on related topics to our research question .Search for relevant published and unpublished literature, including both peer-reviewed and grey reports, will be conducted from the following sources: (1) within bibliographies of relevant reviews; 2) online publication databases, and (3) organization websites and repositories. This systematic map will begin with a rapid search for relevant reviews within the scope of the research question that document and report their search strategy and provide a list of included articles in their review. These reviews will be the basis for backwards citation chasing as a search strategy for identifying an initial pool of potentially relevant sources  to organize and store citations along the stages of this synthesis as it is open access and can be used across the review team. We will remove duplicate citations in Endnote (www.endnote.com) across searches, matching based on title . The online synthesis platform colandr (www.colandrapp.com) will be used to screen citations at title and abstract. Colandr is an online, open-access evidence synthesis platform that has machine learning and text mining features to help improve the efficiency of screening and data extraction [https://www.knack.com) that can be used collaboratively across a team.We will use Zotero . As this study is attempting to describe the state and characteristics of the evidence base, particularly in relation to how the impact of these interventions is being evaluated and where key gaps in evaluation effort may exist, we included a broad range of comparator and data types to provide insight on overall study quality.Comparators will be classified as temporal, spatial, or between groups. Temporal comparators examine effects over time including before and after implementation, interrupted or continuous time series and reported/perceived changes . Spatial comparators that compare effects between sites over distance  will be included. Lastly, between group comparators compare effects between populations either of species/types of ecosystems or humans related to the intervention will be included. This includes comparisons between presence/absence of an intervention as well as across sites within an intervention or across interventions.Non-experimental, quasi-experimental, and experimental study designs that use quantitative, qualitative, or a combination of data typesSystematic reviews and syntheses  that describe the methods used for search, data collection, and synthesis as per the ‘green’ level standards for the Collaboration for Environmental Evidence Systematic Appraisal Tool (CEESAT) We will include primary research articles in English meeting the criteria outlined below:Theoretical or modeling studies, editorials and commentaries will be excludedLiterature reviews which do not describe methods used for search, data collection, and synthesis (e.g. as per ‘red’ or ‘yellow’ level standards for CEESAT)We will exclude the following:We will include studies that assess the impact of NCS interventions on climate change mitigation. We focus on mitigation outcomes for GHG emissions and carbon storage and/or sequestration within aboveground biomass in five tropical terrestrial biomes. As belowground mechanisms of carbon storage and sequestration are important, we will code for articles that also measure impacts belowground in addition to the two listed above.We use categories and subcategories of outcomes as outlined in , 64, adaDue to the volume of studies that are likely to be encountered and the wide breadth of study designs and comparators considered, we will not be critically appraising the validity or robustness of included articles. We recognize that this will limit interpretations from the resulting evidence map and potentially the utility of the map for end users. As such, we will consider this limitation appropriately and fully within the analysis portion of this study. However, we will code aspects of study design  that will provide an initial idea of overall study validity within the evidence base. Furthermore, we will assess the distribution of study designs employed within the resulting evidence map in order to provide guidance on how to assess study quality in the future.Bibliographic details (such as author affiliations)Intervention type and details (as in typology above)Any complementary interventions implemented alongside or in concert with the intervention (and details) Details on adjacent outcomes evaluated in addition to the primary outcomes of interest   as well as eventual downstream impacts . Similarly, efforts such as restoration of degraded ecosystems will have immediate impacts on abundance of certain species, as well as downstream impacts on ecosystem function. We recognize that examining how NCS impacts these socioeconomic and biological domains is critical to understanding the systems-level impacts of these interventions—however, due to the volume of likely resources on these topics, including these outcomes as part of our PICO framework is not feasible.We will, however, examine whether articles that examine impacts on practice and/or climate change mitigation outcomes also examine socioeconomic, biological, and/or ecological outcomes. This approach will allow us to assess the extent of the evidence base that examines potential co-benefits of NCS interventions for climate mitigation and biodiversity or socioeconomic outcomes, as minimizing tradeoffs and maximizing co-benefits is critical to meeting multiple global climate targets and Sustainable Development Goals. We take a holistic view of socioeconomic outcomes that reflect impacts at both the individual, group, and community levels Table . Similaralso measure impacts on soil carbon/belowground alongside changes in aboveground storage/sequestration and/or emissions.Soil carbon storage and sequestration are important components of the mitigation potential of NCS . We willhttps://www.R-project.org/) to enable us to summarize key characteristics and trends. We will summarize the descriptive characteristics of the included studies according to the population, interventions, comparators, biome/ ecoregion, study designs and outcomes and present in visual frequency graphs. We will generate visual representations of the distribution of the evidence base in terms of geographic distribution, as well as types of interventions and outcomes assessed in the current literature (‘heatmaps’). We will use this to identify and characterize the presence of different types of evidence gaps; for example, ‘absolute’ evidence gaps , evaluation gaps , and synthesis gaps . In particular, we will describe the current state and distribution of the evidence base in regards to the number of studies that look at secondary outcomes and compare that to the distribution of studies synthesized in the ‘mega-map’ effort.The final dataset will be formatted for statistical analysis in R (Trends and patterns in the data along with relevant insights for policy, practice and research will be summarized in a narrative report in addition to the graphical display. Final data on excluded literature, included literature, and associated meta-data will also be made available in an online open source repository, and code for analysis will be made available on Github.Additional file 1: Protocol for mega-map.Additional file 2: Search strategy 10–2.Additional file 3: Test library.Additional file 4: Protocol for backwards citation chasing.Additional file 5: Grey literature sources.Additional file 6: Intervention typology.Additional file 7: Outcome typology.Additional file 8: Codebook for data extraction.Additional file 9: ROSES systematic map protocols checklist.


An umbrella review of meta-analyses was performed to summarize the evidence of associations between alcohol consumption and health outcomes and to assess its credibility. Meta-analyses of prospective cohort studies reporting the associations of alcohol consumption with health outcomes were identified. We recalculated the random-effects summary effect size and 95% confidence interval, heterogeneity, and small-study effect for each meta-analysis and graded the evidence. Fifty-nine publications reporting 224 meta-analyses of prospective cohort studies with 140 unique health outcomes were included, in which there were 49 beneficial associations and 25 harmful associations with nominally statistically significant summary results. But quality of evidence was rated high only for seven beneficial associations  risk in patients with hypertension and all-cause mortality in patients with hypertension for moderate consumption) and four harmful associations . In this umbrella review, only 11 health outcomes  with statistically significant showed high quality of epidemiologic evidence. More robust and larger prospective studies are needed to verify our results. According to the data from WHO in 2018, about 2.3 billion people worldwide are current drinkers , 5. The Umbrella review is becoming more and more important for overviewing evidence of published systematic reviews and meta-analyses on a specific topic. Only one recent report that indicated the relationship between different types of alcohol and partial health outcomes of meta-analyses of observational studies . To our Consequently, we performed this umbrella review of meta-analyses that only including prospective cohort studies to comprehensively assess the methodological quality and investigate the potential bias. More importantly, we evaluated the evidence's breadth, strength, and validity on the associations of alcohol consumption with multiple health outcomes. We believe that our work can provide a more concrete basis for formulation of alcohol consumption guidelines.Our protocol has been registered in PROSPERO (CRD42021228480). We followed the preferred reporting items for systematic reviews and meta-analyses (PRISMA) Guidelines .The systematic literature search was conducted in PubMed, Web of Science and EMBASE with no time limit for meta-analyses of prospective observational studies. Search items were “alcohol and meta-analysis,” and no other restrictions were imposed. The literature search was conducted by three authors . Disagreements were resolved by consensus.Meta-analyses were included if they met the following criteria: (1) Meta-analyses included prospective cohort studies; (2) Meta-analyses reported the relationship between alcohol consumption and direct results on human outcome . The protocols, abstracts of the conference, and letters to editors were excluded. We also excluded the study involves animal research and indirect indicators on human health. When several meta-analyses simultaneously reported the same health outcome, we included the one with the largest number of studies.>0 and ≤ 14.9 g/day (about >0 and <1 drink/day), 15–9.9 g/day (about 1–2.5 drinks/day), ≥30 g/day (about >2.5 drinks/day), respectively (One author (LZ) extracted data separately checked by the other authors (WC and TW). For each included meta-analysis, we extracted the following data: the first author's name and publication year. For each primary study in the included meta-analyses, we extracted the name of the first author, publication year, the number of cases and participants, exposure, relative risk (RR), hazard ratios (HR), odds ratios (OR), 95% confidence intervals. Since the amount of alcohol exposure varies in the primary studies, we uniformly classified alcohol consumption levels into three groups based on the primary studies: low, moderate, and high, which were defined as ethanol intake of We used the validated AMSTAR 2 tool  to evaluP < 0.001 (P > 0.10); (3) no evidence of small-study effects (P > 0.10). If all these criteria were satisfied, the strength of the epidemiologic evidence was rated as high. If a maximum of 1 criterion was not satisfied and P < 0.001 was found, the strength of the epidemiologic evidence was rated as moderate. If it is all other cases (P < 0.05), the strength of the epidemiologic evidence was considered weak.We classified evidence from meta-analyses of observational studies with nominally statistically significant summary results into three categories . We evaluated the strength of epidemiologic evidence with the following criteria –17: (1)  < 0.001 , 19, a t2 statistics are the tools to evaluate the heterogeneity between studies. I2 values equal to or exceeding 50% are usually judged to represent large heterogeneity. The Egger's test in which a p < 0.1 is taken as statistical evidence of the presence of small-study effects was used to calculate the publication bias   Figures, 4.Moderate alcohol consumption was found to increase the AMD risk  Figure .High alcohol consumption was associated with an increased risk of completes suicide  Figure . For chrHowever, the low, moderate, and high drinking groups were not associated with 21, 22, and 23 health outcomes, respectively .P > 0.05)  . Figure In low alcohol consumption group, five health outcomes  showed high epidemiologic evidence; 11 health outcomes  showed moderate epidemiologic evidence; and 13 health outcomes showed weak epidemiologic evidence .In moderate alcohol consumption group, five health outcomes  showed high epidemiologic evidence; six health outcomes  showed moderate epidemiologic evidence; 14 health outcomes showed weak epidemiologic evidence .In high alcohol consumption group, only one health outcome (the increased risk of hemorrhagic stroke) showed high epidemiologic evidence; eight health outcomes  showed moderate epidemiologic evidence; 11 health outcomes showed weak epidemiologic evidence .We included 39 publications, which comprised 140 unique meta-analyses of prospective studies. We found the quality of evidence was graded as high for the four beneficial health outcomes  and one harmful health outcome  in low alcohol consumption. For moderate alcohol consumption, the quality of evidence was graded as high for three beneficial health outcomes  and two harmful health outcomes . In the high alcohol consumption, the quality of evidence was graded as high for only one harmful health outcome (the increased risk of hemorrhagic stroke) –7.in vivo and in vitro  stated in 2020 , if alcoad-hoc Working Group Of The Italian Society Of Human Nutrition  and four harmful associations . This reminds us that we should drink in moderation and avoid binge drinking or heavy drinking. To achieve high quality of evidence for the associations of alcohol with the health outcomes and give strong recommendations, more robust and larger prospective studies are needed.The original contributions presented in the study are included in the article/LZ, WC, TW, and ST contributed to the conception and design of the umbrella review. LZ, WC, TW, QZ, LL, JLa, and JLi were involved in the acquisition and analysis of the data. LZ and TW interpreted the results. LZ and ST drafted the manuscript. All authors read and approved the final manuscript.This study was supported by the Special project for high-level talents of the Affiliated Hospital of Youjiang Medical University for Nationalities, in Baise, China (No. R202011703).The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.


Persuasion raises a number of challenges for classical accounts of belief updating, as information cannot be taken at face value. How should listeners account for a speaker’s “hidden agenda” when incorporating new information? Here, we extend recent probabilistic models of recursive social reasoning to allow for persuasive goals and show that our model provides a pragmatic account for why weakly favorable arguments may backfire, a phenomenon known as the weak evidence effect. Critically, this model predicts a systematic relationship between belief updates and expectations about the information source: weak evidence should only backfire when speakers are expected to act under persuasive goals and prefer the strongest evidence. We introduce a simple experimental paradigm called the Stick Contest to measure the extent to which the weak evidence effect depends on speaker expectations, and show that a pragmatic listener model accounts for the empirical data better than alternative models. Our findings suggest further avenues for rational models of social reasoning to illuminate classical decision-making phenomena.Language is not only used to transmit neutral information; we often seek to  While mlatent variable that can be recovered by inverting a generative model of how an intentional agent would share information under different circumstances  and present a series of simulations deriving key predictions from our model. We then introduce a simple behavioral paradigm, the To derive precise behavioral predictions, we begin by formalizing the pragmatics of persuasion in a computational model. Specifically, we draw upon recent progress in the Rational Speech Act (RSA) framework , after hearing an utterance u . According to Bayes’ rule, the listener’s posterior beliefs about the world PL(w|u) may be derived as follows:P(w) is the listener’s prior beliefs about the world and the likelihood PS(u|w) is derived by imagining what a hypothetical speaker agent would choose to say in different circumstances. This term yields different predictions given different assumptions about the speaker, captured by different speaker utility functions U. In existing RSA models, the speaker is usually assumed to be epistemically informative, choosing utterances that bring the listener’s beliefs as close as possible to the true state of the world, as measured by information-theoretic surprisal:α ∈  controls the temperature of the soft-max function and Uepi denotes the utility function of an  informative speaker. As α → ∞, the speaker increasingly chooses the single utterance with the highest utility, and as α → 0 the speaker becomes indifferent among utterances. If this hypothetical speaker, in turn, aimed to be informative to the same listener defined in L0, who takes evidence at face value:u〛 gives the literal semantics of the utterance u, with δu〛(w)〚 returning 1 if w is consistent with the state of affairs denoted by u, and 0  otherwise.We begin by defining a pragmatic listener true beliefs. Often, however, speakers do not seek to neutrally inform, but to persuade in favor of a particular outcome or “hidden agenda.” What is needed to represent such persuasive goals in the RSA framework? We begin by assuming that motivated speakers have a particular goal state w* that they aim to induce in the listener, where w* does not necessarily coincide with the true state of affairs w. This naturally yields a persuasive utility Upers that aims to persuade the listener to adopt the intended beliefs w*:u is strictly more persuasive than u′ if and only if Upers(u|w*) > Upers(u′|w*) . Following prior extensions of the speaker utility to other non-epistemic goals . This motivated speaker forms the foundation for a pragmatic model of the weak evidence effect.L1 who suspects that the utterance was generated by a motivated speaker with non-zero bias β is able to be “skeptical” of the speaker’s agenda and discount their evidence accordingly:w and w* coincide, the speaker is expected to choose a utterance that is strongly supportive of that state; weaker utterances have a lower probability of being chosen. Conversely, if w* deviates from the true state of affairs, stronger utterances in favor of w* will be dispreferred , hence weaker utterances are more likely. In this way, the absence of strong evidence from a speaker who would be highly motivated to show it statistically implies that no such evidence exists.The epistemic utility defined in t al., w :PSuww*∝ethe Stick Contest , common knowledge about the scale allows the weak evidence effect to emerge from a single piece of evidence. This property helps to disentangle the core mechanisms driving the weak evidence effect from those driving We recruited 804 participants from the Prolific crowd-sourcing platform, 723 of whom successfully completed the task and passed attention checks (see Appendix A). The task took approximately 5 to 7 minutes, and each participant was paid $1.40 for an average hourly rate of $14. We restricted recruitment to the USA, UK, and Canada and balanced recruitment evenly between male and female participants. Participants were not allowed to complete the task on mobile or to complete the experiment more than once.speaker expectation phase, and second, a listener judgment phase . The order of contestants was counterbalanced across participants and held constant across the speaker and listener phase.Before quantitatively evaluating our model, we first examine its key qualitative predictions. Do participants exhibit a weak evidence effect in their listener judgments at all, and if so, to what extent is variation in the strength of the effect related to their expectations about the speaker? We focus on each participant’s first judgment, provided after the first piece of evidence in the listener phase. This judgment provides the clearest view of the weak evidence effect, as subsequent judgments may be complicated by order effects. We constructed a linear regression model predicting participants’ continuous slider responses. We included fixed effects of evidence strength as well as expectations from the speaker phase , and their interaction, along with a fixed effect of whether the first contestant was “short”-biased or “long”-biased. Because the design was fully between-participant , no random effects were supported.t(718) = 5.2, p < 0.001; see m = 34.7, 95% CI: , p < 0.001. Meanwhile, for participants who expected speakers to “hedge” and not necessarily show the strongest evidence first , no weak evidence effect was found  = −6.3, p < 0.001.) We found only a marginally significant asymmetry in slider bias, p = 0.056, with short-biased participants giving slightly larger endorsements (m = 1.6 slider points) across the board.As predicted, we found a significant interaction between speaker expectations and evidence strength, u ∈ 𝒰 as the possible lengths of individual sticks the speaker must choose between, the world state w as the true set of sticks, and the persuasive goals w* ∈ {longer, shorter} as a binary proposition corresponding to each speaker’s incentive. Because the speaker only has access to true utterances, all utterances have equal epistemic utility  = Unif(u), thus reducing to the literal listener L0. When β → ∞, the pragmatic listener expects the speaker to maximize utility and choose the single strongest piece of evidence.The qualitative effect observed the previous section is consistent with our pragmatic account: weak evidence only backfired for participants who expected speakers to provide the strongest available. In this section we conduct a series of simulations to explicitly examine the conditions under which this effect emerges from our model of recursive social reasoning between a speaker (who selects the evidence) and a listener (who updates their beliefs in light of the evidence). Our task is naturally formalized by defining the possible utterances u ∈ {5, 6, 7, 8, 9, 10} and manipulate β, which represents the degree to which the pragmatic listener L1 expects the speaker S to be motivated to show data that prefers target goal state w* = longer . We operationalize the size of the weak evidence effect as the decrease in belief for a proposition given positive evidence supporting that proposition. For example, if observing a stick length of 6″ decreased the listener’s beliefs that the sample was longer than 5″ from a prior belief of P(longer) = 0.5 to a posterior belief of P(longer | u = 6) = 0.4, then we say the size of the effect is 0.5 − 0.4 = 0.1.In our simulations, we present the listener models with different pieces of evidence β = 0 , the weak evidence effect is found over a broad range of evidence: if the listener expects the speaker to show the single strongest piece of evidence available, then even a stick of length 8″ rules out the existence of any stronger evidence, shifting the possible range of sticks in the sample. To further understand this effect, we computed the beliefs of literal (J0) and pragmatic (J1) listener models as a function of the evidence they’ve been shown .homogeneous model, assumes the entire population of participants is explained by a pragmatic model (z = L1) with an unknown bias. It is homogeneous because the same model is assumed to be shared across the whole population. The second variant, which we call the heterogeneous model, is a mixture model where we predicted each participant’s response as a convex combination of the J0 and J1 models with mixture weight pz . In the third variant, which we call the speaker-dependent model, we explicitly fit different mixture weights depending on the participant’s response in the speaker expectations phase. Rather than learning a single mixture weight for the entire population, this variant learns independent mixture weights for different sub-groups zj, defined by the different sticks j that participants chose in the speaker phase. This model asks whether conditioning on speaker data allows the model to make sufficiently better predictions about the listener data.We considered several variants of the RSA model, which handled the relationship between the speaker and listener phase in different ways. The simplest variant, which we call the asocial models accounting for the weak evidence effect are anchor-and-adjust (AA) models. In these models, individuals compare the strength of new evidence u against a reference point R and adjust their beliefs P(w|u) up or down accordingly:s(u) is the strength of the evidence, and η is an adjustment weight. In the simplest variant  = 1 − P(w) = .5 and R = 0. In a more complex variant, beliefs are not updated from a neutral baseline but instead relative to more stringent level known as the argument’s “minimum acceptable strength”  estimate of J1 model best explained the judgments of participants who expected the strongest evidence to be shown during the speaker phase (mixture weight z = 0.99) while the literal J0 model best explained the judgments of participants who expected weaker sticks to be shown (mixture weight z = 0.1). Full parameter posteriors are shown in Figure S5.We examined several metrics to assess the relative performance of these models.weak evidence effect via a model of recursive social reasoning, where weaker evidence may backfire when the speaker is expected to have a persuasive agenda. This model critically predicts that individual differences in the weak evidence effect should be related to individual differences in how the speaker is expected to select evidence. We evaluated this qualitative prediction using a novel behavioral paradigm—the Stick Contest—and demonstrated through simulations and quantitative model comparisons that our model uniquely captures this source of variance in judgments.Evidence is not a direct reflection of the world: it comes from somewhere, often from other people. Yet appropriately accounting for social sources of information has posed a challenge for models of belief-updating, even as increasing attention has been given to the role of pragmatic reasoning in classic phenomena. In this paper, we formalized a pragmatic account of the order effects that have been the central focus of previous accounts , presentation effects , and social affiliation effects  that have been examined in real-world settings of persuasion . Based on the self-explanations we elicited (Table S2), it is possible that some participants who expected less strong evidence were reasoning in this way. These individual differences are consistent with prior work reporting heterogeneity in levels of reasoning in other communicative tasks  and self-explanations (Tables S2–S3), which suggest a thoughtful rationale for expecting weaker evidence. However, an alternative solution would be to explicitly manipulate social expectations about the speaker in the cover story . Such a design would license stronger causal inferences, but would also raise new concerns about exactly what is being manipulated. A second limitation of our design is that the speaker phase was always presented before the listener phase. It is already known that the order of these roles may affect participants’ reasoning  Importantly, this effect is sensitive to the perceived expertise of the source; no such implication follows for unknowledgable informants  posteriors accordingly—refer to Appendix E for details.Although we formulate the listener’s posterior as being conditioned on a 4 long-biased speaker; we report results from this version in Appendix D.An earlier iteration of our experiment only used a 5 For related tasks studying outright lying, see Franke et al. , Oey et 6 α · β is non-zero only if the persuasion weight β is non-zero, these two parameters are redundant in our task. We thus treat their product as a single free parameter, effectively fixing α = 1. It is possible that a near-zero α  may make it difficult to empirically detect a non-zero β term in our model comparison below, but this would work against our hypothesis.Because the product 7 https://github.com/s-a-barnett/bayesian-persuasion.All models were implemented in WebPPL (Goodman & Stuhlmüller, 8 We drew 1,000 samples from the posterior via MCMC across four chains, with a burn-in of 7,500 steps and a lag of 100 steps between samples.Click here for additional data file.