Date of Award

11-2025

Degree Type

Thesis

Degree Name

Master of Bioethics

First Advisor

Dr. Robyna Irshad Khan

Second Advisor

Dr. Paul Ndebele

Third Advisor

Dr. Mustafa Aslam

Department

Educational Development

Abstract

Background: Transgender individuals are historically underrepresented in clinical research. In Pakistan, transgender individuals often face stigmatization and systemic exclusion from healthcare access due to challenges including no trans-health education in medical curriculum, lack of knowledge among healthcare professionals to treat and care for transgender community, institutional inefficiencies, and weak existing regulatory frameworks. Exploring the perceptions of clinical researchers regarding the inclusion of transgender individuals in clinical research is essential for improving the healthcare outcomes of this vulnerable population. Ensuring equitable inclusion in research is therefore essential to understanding and addressing the health disparities faced by this population. Objectives: This study aimed to understand the clinical researchers’ perspectives on the inclusion of transgender individuals in clinical research in a Pakistani academic research context, and to identify key barriers and formulate suggestions to ethically improve this inclusion.
Methods: An exploratory descriptive qualitative study design was employed to assess the clinical researchers’ perceptions of barriers to including transgender individuals in clinical research adopting the Diversity, Equity, and Inclusion (DEI) Framework. In this study, twelve purposively selected study participants were interviewed using a semi-structured in-depth interview guide at a private sector tertiary care academic institution in Karachi, Pakistan. Findings were integrated through triangulation with existing literature to ensure depth and validity.
Results: The study participants considered transgender individuals as a vulnerable population and acknowledged the need to include them in clinical research. Findings from the qualitative interviews highlighted that societal and cultural influences act as primary invisible barrier to transgender individuals’ inclusion, followed by lack of institutional policies and guidance of clinical researchers, training deficiencies within researchers, and research design complexities. The findings suggested strong structured institutional guidelines, training clinical researchers increasing sensitization towards this issue, participatory community engagement, and modifying research designs to consider ethical inclusion of transgender individuals.
Conclusion: Transgender individuals in Pakistan are considered a vulnerable and marginalized population having limited access to healthcare system. There exists a clear contrast in recognizing the need for inclusion with practical steps towards improving inclusion in clinical research. Formulating institutional guidelines, integrating trans-health education in curriculum, institutionalizing sensitization, structured training for clinical researchers, and adopting inclusive research designs are critical to improve ethical inclusive research practices

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1

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149

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