| Priyanka Rajkhowa Research Scholar Department of Mass Communication Rajiv Gandhi University (Arunachal Pradesh) India | Prof. Kh. Kabi Department of Mass Communication Rajiv Gandhi University (Arunachal Pradesh) India |
Abstract
In India there has been limited studies conducted related to health care among the transgender community. India, a land of diversity has been ignorant about the third gender population. According to the census 2021, the total transgender population in India is 4.87 lakhs. According to the 2011 census Assam’s transgender population is 11,000. There are various areas where this community in Assam, faces discrimination and health being one prime area. Discrimination in regard to healthcare facilities among the transgender community in Assam is very high. The study attempts to analyse the online health information seeking behaviour among the transgender community in Kamrup metro district of Assam. The study also analyses the health issues that the transgender community mostly seek information about through online platforms. Applying the Uses and Gratification theory and diffusion of innovation theory the study is an attempt to understand the role of mobile phones in health communication among the transgender community of Assam. The samples for the study are chosen applying the snowball sampling technique. Focus group and in depth interviews were conducted to fulfil the objectives of the study.
Keywords: Health Communication, transgender, Online health seeking behaviour, health literacy.
1. Introduction
Health is one of the central aspects of human life. The World Health Organisation (WHO) defines health as “Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.” Health is one of the most important parameters of development indicator. Irrespective of age, gender, socio-economic background or ethnic background health is one of the most essential assets. Right to health is a fundamental right entitled to every human being. The right to health was recognised as a human right in the year 1966 at the International Covenant on Economic, Social and Cultural Rights. Any country with a population irrespective of gender, socio economic background with a sound mental and physical health is considered to be developed.
In similar context , Patrick et.,al, 1973 p. 7, states “health status is a composite of an individual’s level of function at a point in time and his expected transition to other levels, more or less favourable, at future times. Precisely stated, health status is the product (expected value) of the social preferences assigned to levels of function and the probabilities of transition among the levels over the life expectancy of an individual or a group.”
Access to health care, and timely access to health information can reduce the risk of vulnerability to various health issues. In this context health communication plays a crucial role. Ishikawa, Kiuchi, 2010 states that ,health communication focuses on improving health of individuals and populations. Schiavo, 2007 defines the key objective of health communication as to influence individuals and communities with the primary aim to improve health conditions by sharing health related information. The process of health communication aims to improve health outcomes with different communication strategies which encourage behaviour and social change. Effective health communication can help people adapt healthy lifestyle choices.
Within the health communication field, communication is conceptualized as the central social process in the provision of health care delivery and the promotion of public health. The centrality of the process of communication is based upon the pervasive roles communication performs in creating, gathering, and sharing health information. Health information is the most important resource in health care and health promotion because it essential in guiding strategic health behaviours, treatments, and decisions (Kreps, 1988).
The study is an attempt to understand the role of effective health communication among the transgender community of the Kamrup metro district of Assam.
With the advancement in ICT, there has been significant changes in the field of health communication. Technological advancement in the field of communication has changed the way information is disseminated and received particularly in the field of health communication system. Yifeng Hu (2015) explains how the role of technology has changed the health care system and how people have changed the way they seek information on health related issues. “For example, the Internet offers a wealth of health information to consumers; online forums provide social support to both patients and caregivers; and mobile technology (e.g., text messaging) is used for health promotion campaigns. Technology usage also impacts how patients receive services, cope with health concerns, and interact with physicians. It has also changed how health professionals perform clinical practices (e.g., adoption of electronic health records) as well as how they undergo medical training and education (e.g., virtual worlds for continuing medical education).”
In similar context Harrington & Head (2015) states that health information sharing has been made easier through digital media platforms. The evolution of Health Information Technology (HIT) has lead to two components , health information exchange (HIE) and electronic health records (EHR). Health information exchange (HIE) refers to exchange of health information digitally. The data related to health are collected and are exchanged through computing platforms like softwares, websites. Electronic health records (EHR) are digital medical records about patients that the healthcare professionals and organisations keeps about their patients, which helps in promoting effective and efficient medical care. EHRs helps patients to make appointments, access tests reports and communicate with doctors through email, instant message and video conferences.
With the change in healthcare system and the health communication scenario with the emergence of internet and various social media platforms, there has been a significant change in seeking health care and health information. With easy access to health information through various online platforms, accessing health information has been easier now. The use of mobile phones to avail health information by individuals is rising. According to Dias and Victor (2022), mobile devices are affordable and provide instant access to wealth of resources. Mobile communication technologies have proved efficient in health communication, especially among youths. Mobile phones and internet provide easy access to health-related information. Bol and Smit (2020), states that information tailoring, which refers to information relevant to access personally by people via mobile phones and websites are effective and cost-efficient method of health communication. These contents are easily available over the technologically advanced media, over internet or through mobile phones. Interactive feature of the social media has been a major factor that attracts users to share and seek health information online. Perceived interactivity has an impact on health information sharing over social media platforms. The study further categories perceived interactivity into two categories, which are human to human and human to information interaction (Lin &Chang,2018).
The use of mobile phones in seeking health information has been present among the transgender community. According to Morse et.al.(2023), transgender people faces various health issues. Transgender people experience trauma, abuse and violence throughout their life. There are various factors which contributes to their poor health conditions which are unstable income, stigma, ignorance and social discrimination, lack of social support, social exclusion, rejection, stress and mental illness. Augustaitis et.al,(2021), states that individuals who are referred to as transgenders are the ones whose current gender is different from the gender that was assigned at birth. The study further states that the transgender people faces various difficulties in regard to health care access and hence they seek health information online often. Rajpurohit & Sharma,2021 states “historically, transgender persons have faced discrimination and harassment based on their gender identity, both in their personal lives and within the context of the healthcare system”.
The study will focus on the various health issues faced by the transgender people of Kamrup Metro district of Assam. The study will further focus on the online health information seeking behaviour among the transgender people and role of mobile phones in accessing health information online by the transgender people in Kamrup Metro district of Assam. Saikia, 2024 states that similar to the rest of the country, the transgender people in Assam are deprived of basic human rights, by their educational institutions and also at public places. The transgender community of Assam faces discrimination in the health sector. The community is highly prone to sexually transmitted diseases like HIV AIDS. The state government is yet to formulate any scheme related to health care for the transgender community of Assam.
1.1 Objectives of the study
The study will aim at fulfilling the following objectives:
- To identify the primary health issues faced by the transgender people in Assam.
- To analyse the role of mobile phones in online health information seeking behaviour by the transgender community in Kamrup district of Assam.
- To examine the reason behind seeking health information online through new media platforms by the transgender community of Kamrup district, Assam.
1.2 Research Questions
The study will answer the following research questions:
RQ1. what are the primary health issues faced by the transgender people in Assam?
RQ2. What is the role of mobile phones in online health information seeking behaviour by the transgender community in Kamrup District of Assam?
RQ3. What are the reasons behind seeking health information online through new media platforms by the transgender community of Kamrup district of Assam.
1.3 Theoretical Framework
For a critical understand of the research problem, the study is conducted within the framework of the following two theories.
Uses and Gratification Theory: Weiyan 2015, states that, the uses and gratification approach has a long history in mass media research. The theory suggests what media users do with the media. The uses and Gratification theory, explain how people or the masses use the media to satisfy their own needs. According to Katz, Gurevitch, and Haas, 1973 the five gratifications derived from media usage are, Cognitive needs which includes depriving gratification through aquring knowledge and information, affective needs which is deriving emotional satisfaction, Integrative needs which provides confidence to the users, social integrative needs which provides the gratification of maintaining a good social relation and staying connected with family and peers, and tension release needs which provides escapism and relaxation.
In context of the study, the uses and gratification theory is used to study the cognitive need derived by the users by using the mobile phones to seek health information online through various digital media platforms.
Diffusion of innovation theory: The diffusion of Innovation theory, developed by E.M.Rogers in 1962, states how masses adapt to new technologies and how it affects their behavioural changes, change in attitude and change in the process of acquiring knowledge. The term diffusion refers to the process by which an innovation or technology is communicated to the members of a society using various communication channels. The theory explains how over time any idea or technology gets recognition and how it penetrates into a social system, and as people being a part of the social system starts adopting new ideas, practices and technologies, new idea, behaviour or a product. While promoting any new ideas, technologies or an innovation there are five stages- (i) innovators, (ii) early adopters (iii) early majority (iv)late majority and (v) laggards.
The study applies the Diffusion of Innovation theory to understand how the transgender community is adapting to the new technologies and accessing health information online through internet access and mobile phones. The study further aims to understand the behavioural changes in health information seeking in by the transgender community of Assam after the advances in the mobile communication sector.
1.4 Statement of the problem
The use of mobile phones in seeking health information has been present among the transgender community. Saikia, 2024 states that similar to the rest of the country, the transgender people in Assam are deprived of basic human rights, by their educational institutions and also at public places. The transgender community of Assam faces discrimination in the health sector. The community is highly prone to sexually transmitted diseases like HIV AIDS. The state government is yet to formulate any scheme related to health care for the transgender community of Assam. The study focuses on the various health issues faced by the transgender people of Kamrup Metro district of Assam.
The study further focuses on the online health information seeking behaviour among the transgender people and role of mobile phones in accessing health information online by the transgender people in Kamrup Metro district of Assam and also the need and importance of health literacy among the community.
1.5 Review of Literature
A literature review is a crucial component of any research, since it identifies current literature, offers insights into the research subject, and highlights gaps to ensure the research’s relevance. For the purpose of the study, literature available about online health seeking behaviour and seeking of health information through online platforms by the transgender community is conducted.
The trend of seeking health information online is rising. In the era of web 2.0 social media is rapidly influencing the daily lives of people and bringing a change in their health behaviour (Zhao & Zhang,2017).
Jia et.al.2019, states that, “With the proliferation of information and communication technology, utilizing the Internet to seek health information becomes a prevalent behaviour. Recently, seeking health information online has become a preferred way due to its availability and coverage of information, the convenience of searching, affordability of access, interactivity and anonymity.”
The population of people seeking health information online is now growing. The internet is used for communicating health related issues (Noorsuriani.et.al, 2017). on a similar note Steele (2011), mentioned that social media platforms and interaction with mobile phones have impacted health communication to a great extent. With the penetration of internet and mobile phone technologies people have now access to a wealth of information on health issues. The present study focuses on the use of internet for health seeking behaviour among the transgender community of Kamrup district of Assam.
Pho.et.al,2021 opines that the transgender community has unique health needs “such as gender-affirming hormone therapy, which may motivate them to seek health information online”. Transgender individuals encounter challenges in obtaining healthcare from providers, leading them to frequently seek health information online, (Augustaitis & Merrill, 2021).
“Transgender persons suffer significant health disparities in multiple arenas. Real or perceived stigma and discrimination within biomedicine and the health care provision, in general, may impact transgender people’s desire and ability to access appropriate care” (Rajpurohit & Sharma,2021). The study further states that, the transgender community are in greater risk of health issues as they donot seek healthcare through health practitioners when needed. The reasons behind the transgender community not seeking healthcare directly can be, embarrassment, fear of judgement or may be they access healthcare through uninformed sources.
According to Alikunju & Sulochana,2024, the transgender community is drawn to the online platforms for health information seeking due to the personal space it provides, along with freedom from social judgements. However it is important to know about the credibility of the information that the online platform proivides.
Gap In Literature
After reviewing the existing literatures certain gaps have been identified. Limited studies have been found regarding the health seeking behaviour among the transgender community. There has been no significant study conducted in the online health seeking behaviour among the transgender community of Assam. There has been no further significant study about need for strategic health communication for the transgender community of Assam. Furthermore during the review of the existing literatures no significant study was found about the need and importance of health literacy among the transgender community of Assam and the Kamrup district of Assam.
Thus, based upon the above observation the present study proposes to fulfil the gaps in literature by focusing to identify the primary health issues faced by the transgender people in Assam, and the reason behind health seeking behaviour through online platforms among the transgender community of the Kamrup district of Assam. The study will also focus on the need of health literacy among the transgender community.
1.6 Methodology
The study is primarily based on qualitative data. The present study employs the method of focus group discussion. Hennink, 2014 opines that, focus group discussions arewidely applied to health, social science and behavioural research; strategic planning; healthpromotion; policy development; program evaluation and other areas of social science research. To understand the reason behind online health information seeking behaviour among the transgender community of the Kamrup district of Assam, focus group discussion will be conducted.
In depth interview is also conducted to know about the various health issues the transgender community faces.
1.6.1.Area and Population of the study: the study is conducted in the Kamrup district of Assam. The Kamrup district comprises of the metropolitan area of the Kamrup District area with a total area of 1,528 Sq. Km. For the purpose of the study, Guwahati city is chosen as the area of study. The Kamrup metropolitan district is divided into six sub districts namely, Azara, Chandrapur, Dispur, Guwahati, North Guwahati and Sonapur. For the purpose of the present study the samples of the study are chosen from the Guwahati sub district. From the Guwahati sub district, Ullubari is chosen as the study area.
1.6.2. Sample Size: A total of 30 members from the transgender community belonging to the age group of 18 to 35 is taken as the sample size for the study. The total population is further divided into three groups, each with 10 members for the focus group discussion.
In depth interview a counsellor of the Humsafar Trust, Guwahati was taken. Humsafar Trust, located Guwahati provides comprehensive services for LGBTQ+ people, including as legal help, mental health, dietary counselling, and HIV/STI clinics.
1.6.3. Sampling Technique: The samples for the study are chosen applying the snowball sampling technique.
1.6.4. Tools For Data Collection: For the collection of primary data, focus group discussion was conducted by the researcher, who is also the moderator, by asking open ended questions. For the in depth interview, open ended questionnaire was provided to the counsellor. For the collection of secondary data, existing literatures were reviewed.
1.7. Results and Discussions
1.7.1. Findings from the Focus Group Discussions:
- The common health issues the transgender community of Assam seek information online are, mental health issues mostly depression and social isolation. Further health information about sexual health are mostly seeked online.
- Use of mobile phones specifically smart phones with internet connectivity provides faster information, tailored contents and provides the community a more personal space.
- The use of mobile phones is highly prevalent among the transgender community of Assam, when it comes to accessing health information through various digital media platforms.
- the reason behind seeking health information through digital media platforms are:
a) They find the medium very comfortable compared to visiting a medical practitioner as it gives them privacy.
b) Seeking health information online helps them openly discuss the issue which is not possible when they visit health centres or doctors where they are often stereotyped or many times denied basic healthcare due to gender discrimination.
1.7.2. Findings from the in depth interview:
An in depth interview of the counsellor of Humsafar Trust was taken to fulfil the research objectives of the study. The findings of the interview are:
- The transgender community faces many problems in Assam like Social Stigma discrimination, economic barriers etc.
- The common health issues faced by the transgender community are STIs, cancer, gender dysphoria, reproductive health issues.
- they face discrimination in availing healthcare facilities because of their identity lack of awareness and training among health care providers
- Through Mobile phone they feel comfortable to open up , discreet person can hide their identity and talk openly, mobile phone give a private platform to talk about their health issues.
- the strategies in health communication required for the transgender community of Assam are training of the health care providers about transgender community, use of peer educators, inclusive media campaigns as information provided online are not enough.
1.8 Conclusion
Digital media, especially smartphones with internet connectivity, are central to how the transgender community in Assam seeks health-related information, with a strong focus on mental health issues (such as depression and social isolation) and sexual health concerns. The preference for mobile platforms is fueled by the privacy, comfort, and autonomy they provide, enabling individuals to avoid the stigma and discrimination frequently encountered in traditional healthcare environments. Discrimination—driven by social stigmas, lack of awareness, and insufficient healthcare provider training—creates serious obstacles to accessing vital services such as treatment for STIs, cancer, reproductive health needs, and support for gender dysphoria. Digital activism and online peer support networks have also emerged as safe spaces to share experiences, organize collective action, and facilitate outreach on topics that are often neglected or stigmatized in mainstream clinical settings ((Poteat et al., 2013).
Mobile technology has emerged as a valuable and inclusive medium for health communication, especially for sensitive conversations, by allowing transgender individuals to discuss their health concerns without fear of discrimination or stigma. However, the study further shows that digital platforms alone cannot eliminate long-standing inequities in healthcare access and delivery for the transgender community.
To avail euality in healthcare availability and access the following must be implemented:
- Healthcare provider training on transgender-specific health needs and gender-affirming care is essential for reducing prejudice and ensuring respectful, knowledgeable treatment.
- Peer educator involvement empowers community members to deliver trusted information and support through shared experiences and perspectives.
- Inclusive media campaigns can help shape public attitudes, break down stigma, and provide reliable health education, ensuring that information truly reaches those who need it most. A multi-faceted approach bridging digital innovations, community engagement, and healthcare provider education is vital to connecting the transgender community in Assam with formal health systems. This combination can help build a more responsive, inclusive, and equitable public health environment for all.
1.9 Scope of Further research
This study offers important insights into how mobile-based digital platforms support health information seeking within Assam’s transgender community, while also highlighting several areas for further inquiry. Future investigations could evaluate the impact of tailored health communication initiatives—such as inclusive media outreach and peer-led programs—on enhancing health literacy and increasing service utilization among transgender individuals. Longitudinal research could track behavioural shifts and health outcomes linked to improved access to digital health resources.
Since the present findings are drawn primarily from a small number of focus groups and a single key informant, subsequent studies should broaden both geographic coverage and participant diversity, particularly by including transgender persons from rural and remote regions where internet availability and digital skills may vary significantly. Comparative analyses of digital versus in-person health communication could also help identify which approaches most effectively reduce stigma and improve access to care.
In addition, research could explore healthcare providers’ training needs and changes in attitudes following sensitivity and inclusivity workshops, as well as examine how policy frameworks can institutionalize transgender-friendly healthcare practices in Assam. Insights from these areas could contribute to a holistic, evidence-driven strategy for addressing persistent health communication and service delivery gaps affecting the transgender community.
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