Lived experiences, health-seeking behaviour, quality of life, and self-esteem among transgender women: a mixed methods study from the Northern Himalayan region.

BACKGROUND: Transgender people are more likely to experience heightened risks of physical and psychological distress and tend to report a poorer quality of life compared to the general population. This study aimed to determine the quality of life and self-esteem, health-seeking behaviour, and to explore the lived experiences among transgender women. METHODS: Using the snowball sampling technique, 73 transgender women were included in this mixed-methods study. Quantitative data were collected through the Short-Form-12 (SF-12) and the Rosenberg Self-esteem Scale (RSES). Maximum variation sampling was employed to select 10 participants for the qualitative component, aiming to gain in-depth insights into their personal experiences and health-seeking behaviours. Appropriate descriptive and inferential statistics were applied for analysis. A thematic analysis approach was used to represent qualitative findings. RESULTS: The mean age of the participants was 30.93 (SD = 4.70) years. Findings revealed that participants had poor mental (Mean µ = 38.80) and physical (Mean µ = 38.08) health. The cohort demonstrated a notably high level of self-esteem (Mean µ = 30.93 ± 4.70). A substantial proportion (76.7%) of participants experienced discrimination or mistreatment while seeking healthcare services, stating unfavorable experiences (19.2%) and strongly unsatisfied (5.5%), whereas more than half (56.2%) avoided giving any opinions. From the qualitative analysis, three major themes emerge: discovering my true identity as transgender person, survival in a world of discrimination, violence, and trauma, and struggle with economic, professional, and legal challenges. CONCLUSIONS: In our study, participants reported lower mental and physical health, experienced discrimination, and had negative perceptions while accessing health services. The study carries important implications for the development of inclusive and high-quality healthcare services to ensure transgender people's access to and utilization of healthcare.