The factors were: teachers' methodological deficiencies; academic over-burden; beliefs about performances; public interventions; negative social environment; exams; content worthlessness; and participation difficulties.
In ophthalmology there are high quality validated vision and glaucoma PRO instruments covering a wide range of content (e.g. visual impairment, visual symptoms, treatment satisfaction, activity and participation difficulties) [ 9].
Where parents or teachers are seen as contributing factors to the participation difficulties of a child, this has to be made transparent, if such information is relevant for establishing eligibility.
Women who organized a campaign starting more than year ago to win the right to vote were particularly incensed when the government rolled out an old excuse to ban their participation — the difficulty of separating polling stations by gender, as custom dictates.
Half of the potential patients were not enrolled due to a combination of inability to obtain suitable consent, frailty, declining participation and difficulty scheduling convenient appointment times.
We need to be able to pinpoint the source of non-participation: (i) competing priorities and time pressure for researchers that may limit their participation; (ii) difficulty with learning how to use the submission tool; or (iii) a lack of understanding about the type of data that can be submitted.
Of the 34 participants who did not participate in the prospective phase, the most frequent reason for non-participation was difficulty attending the study clinics on a weekly basis due to transport and/or distance problems.
However, serosurveys also pose notable challenges, including the need to obtain community and individual family participation and difficulties in collecting venous blood samples from infants and toddlers in remote conditions and maintaining the integrity of specimens with a cold chain.
Further complexities in community participation include difficulties in defining 'communities' and their 'representatives', and differing perceptions and motivations among key stakeholders at national and local levels regarding if and how to involve communities [13,15 21].
Exclusion criteria were expected survival less than three months, cognitive impairment or mental illness that could affect informed consent or active participation, and difficulties to speak or understand Swedish.
