Consequences of genomic literacy elements on genetic testing decisions among Emirati adults: a cross-sectional study

Background

Genomic literacy is an essential determinant of informed participation in genetic testing. Guided by Nutbeam’s Health Literacy Model, this study examined how components of genomic literacy (genetic/genomic knowledge, health numeracy, and communicative and critical health literacy) predict Emirati adults’ risk and benefit perceptions and behavioural intentions regarding genetic testing, and explored whether demographic and experiential factors moderate these relationships.

Methods

A community-based cross-sectional survey was conducted among 300 Emirati adults aged 18–59 years in Ras Al Khaimah, UAE. Participants completed validated instruments assessing genomic knowledge, health numeracy, communicative and critical health literacy, and perceptions of risk and benefit. Data were analysed using descriptive statistics, Pearson correlations, and linear regression to identify predictors of genetic testing intention and result disclosure.

Results

Communicative and critical health literacy emerged as the strongest predictors of intention to undergo testing (p < 0.001). Health numeracy and genomic knowledge significantly predicted willingness to disclose positive results to partners and children. Benefit perception showed an inverse association with testing intention (p = 0.038). Demographic factors, including age, marital status, and prior genetic exposure, influenced literacy levels and decision patterns.

Conclusions and implications

Genomic literacy particularly communicative and critical literacy plays a pivotal role in shaping genetic testing decisions in Emirati adults. These findings highlight the need for integrated genomic education within nursing and medical curricula and culturally tailored public health interventions that strengthen literacy, numeracy, and counselling access to support informed decision-making in genomic medicine.

Highlights

Communicative and critical health literacy become the strongest indicators of Emirati individuals intention to undergo genetic testing.

Health numeracy and genomic knowledge have a strong predictive power on the willingness of individual to reveal genetic test-based information to partners and children.

A program of genomic literacy education tailored to include communication, numeracy, and critical appraisal skills is the way to promote informed decision-making related to genetic testing.

Advocacy in policy is also inseparable in order to support fair access to genetic counseling services in the United Arab Emirates.

Introduction

Genomic variations play a critical role in health and disease, influencing susceptibility to genetic disorders and environmental factors. Advances in genomic medicine have made genetic testing a critical tool for disease prevention, diagnosis, and personalized treatment. However, the translation of these advances into practice depends heavily on the public’s level of genomic literacy which is the ability to comprehend, analyze and use genomic data when making decisions about individuals health [1].

Genetic disorders remain a major public health challenge worldwide, with over 80% of rare diseases attributed to genetic causes [2]. In the United Arab Emirates (UAE), the high rate of consanguinity has contributed to the burden of genetic diseases, with more than 270 conditions identified in the Emirati population [3].

Genomic medicine in the United Arab Emirates (UAE) has gained national prominence through initiatives such as the Emirati Genome Programme, which utilizes cutting-edge sequencing and artificial intelligence to profile the population’s unique genetic makeup [4]. On January 2025, mandatory genetic testing has been incorporated into premarital screening for Emiratis to diminish the incidence of hereditary diseases, reflecting a paradigm shift in preventive healthcare [5, 6]. Despite government initiatives such as the Emirate Genomic Project, gaps remain in the public understanding and acceptance of genetic testing [7, 8].

Genomic literacy is widely acknowledged as a factor influencing informed decision making recognized. Individuals with higher literacy are better equipped to balance the benefits, hazards, and ethical considerations of testing, leading to deliberate choices and informed consent [9]. Conversely, low genomic literacy is associated with misinterpretation of results, psychological distress, and limited engagement with genomic services [10, 11]. Importantly, socio-cultural and ethical contexts, such as religious beliefs, privacy concerns, and family influence, shape decision-making in ways that extend beyond factual knowledge [12].

Even though international studies have begun to explore how literacy influences decisions about genetic testing, evidence from the Middle East and North Africa (MENA) region, particularly the UAE, remains limited. Prior research has highlighted public interest in genomic testing but also pointed to cultural barriers and insufficient awareness as obstacles to participation [7, 8, 13]. There is a notable deficit of nuanced MENA-focused evidence addressing how functional, interactive, and critical literacy interact with sociocultural, policy, and familial factors to influence genetic testing uptake and disclosure behavior [14]. Addressing these gaps is vital to ensure that large-scale genomic initiatives achieve their intended benefits.

Conceptual framework

Nutbeam’s Health Literacy Model describes health literacy as encompassing three key domains: functional, interactive, and critical literacy. Functional literacy involves basic skills in reading, writing, and numeracy necessary to interpret and use health information (knowledge, numeracy). Interactive literacy encompasses more advanced cognitive and communication abilities that facilitate active engagement with health content and application of information to changing circumstances (communication and comprehension). Critical literacy represents the highest level of cognitive and social skills, enabling individuals to critically analyze information, evaluate risks and benefits, and make informed decisions that influence their health outcomes (appraisal and advocacy) [15–17].

For the purposes of this research study, genomic literacy is conceptualized as an extension of Nutbeam’s health literacy domains to the context of genetic and genomic information. Functional genomic literacy is reflected in respondents’ factual knowledge of genetic concepts and their capability to comprehend and apply numerical information about genetic risk (health numeracy). Communicative genomic literacy denotes the ability to access, understand, and discuss genomic information with others, while critical genomic literacy refers to the capacity to appraise the credibility, implications, and ethical dimensions of genetic testing and to use this appraisal in decision‑making. Together, these dimensions provide a comprehensive framework for examining how individuals engage with information about genetic testing within the Emirati context these domains provide a comprehensive framework to assess how genomic literacy influences individuals’ perception and interpretation of risk and benefit information related to genetic testing, thereby shaping their decision-making processes. Functional literacy supports basic understanding of genetic concepts and numerical risk data, while interactive and critical literacy enhance the ability to appraise the personal relevance and credibility of information about genetic testing benefits and risks, ultimately empowering informed decision-making [16, 17].

Addressing genomic literacy within the Emirati context directly supports the United Nations Sustainable Development Goal 3 (SDG 3), which aims to ensure healthy lives and promote well-being for all at all ages. By enhancing individuals’ understanding and informed decision-making about genetic testing, this study contributes to critical targets related to the prevention and management of non-communicable diseases through early detection and personalized interventions. Integrating genomic literacy into public health initiatives aligns with global efforts to reduce health inequities and advance precision health, underscoring the imperative to expand equitable access to genetic services and education as part of sustainable health system strengthening [18]. The conceptual framework guiding this study, based on Nutbeam’s Health Literacy Model, is presented in Fig. 1

Fig. 1.

Research framework

The study aims to examine how genomic literacy components (genetic/genomic knowledge, health numeracy, and communicative and critical health literacy) influence Emirati adults’ perceptions of the risks and benefits of genetic testing and their behavioral intentions. In addition, we sought to explore whether demographic characteristics and experiential factors related to genetics moderate the associations between genomic literacy, risk–benefit perceptions, and these behavioural intentions, using correlation and multivariable linear regression models. Drawing on Nutbeam’s Health Literacy Model and prior genomic literacy research, the study was guided by the following hypotheses.

• H1: Higher levels of genomic literacy components (genetic/genomic knowledge, health numeracy, and communicative and critical health literacy) are associated with more favourable risk and benefit perceptions of genetic testing.

• H2: Genomic literacy components positively predict behavioural intentions, specifically intention to conduct genetic testing with the purpose of beneficial findings to partners and to children.

• H3: Communicative and critical health literacy exhibit stronger positive associations with behavioural intentions than functional literacy components (genetic/genomic knowledge and health numeracy).

• H4: Demographic and experiential factors (age, sex, marital status, parenthood, education level, occupation, biology education in high school, prior learning about genetics, and family history of genetic disease) moderate the relationships between genomic literacy components, risk and benefit perceptions, and behavioural intentions toward genetic testing and result disclosure.

Materials and methods

Study design and setting

A cross-sectional survey design was employed to assess genomic literacy and decision-making regarding genetic testing among Emirati adults in Ras Al Khaimah, the UAE. The study was conducted between April and July 2025. The reporting of this study adhered to the STROBE guidelines for cross-sectional studies to ensure methodological rigor and transparency [19].

This study aimed to evaluate the impact of genomic literacy elements on decision-making related to genetic testing among Emirati adults. The UAE’s advancing genomic research environment, driven by initiatives such as the Emirati Genome Program, includes efforts to develop a population-specific reference genome and promote personalized, preventive healthcare [4].

Population and sample

Data were collected from Emirati nationals aged 18—59 years residing in diverse community settings within Ras Al Khaimah. Recruitment sites encompassed residential areas (villas and standalone houses), commercial zones (souqs, shopping malls, and supermarkets), and public institutions (schools, colleges, community centers, parks, and beaches), ensuring representation across socioeconomic and demographic groups. Convenience sampling was employed to recruit eligible Emirati adults who were accessible and willing to participate during the data collection period, which coincided with the early implementation phase of mandatory premarital genetic testing. To mitigate some of the limitations inherent to non‑probability sampling, recruitment was deliberately conducted across diverse community settings including residential areas, commercial zones, and public institutions to capture variation in sociodemographic characteristics and health backgrounds.

The eligibility criteria included Emirati nationality, age between 18 and 59 years, and voluntary informed consent. The exclusion criteria comprised non-Emirati residents and individuals younger than 18 or older than 59 years to maintain sample homogeneity relevant to national health priorities.

The minimum required sample size was calculated using the following formula: n = 4p(1 − p)/SE²n where: n = sample size, p = expected awareness (50%), and SE = sampling error (5%). Based on this calculation, a sample size of 310 participants was determined to achieve adequate statistical power [20].

Research instrument

A structured, self-administered questionnaire was used to collect the data comprising of six parts that incorporated validated scales adapted from established literature.

1. Demographic and genetic history included gender, age, marital status, children, educational level, occupation, biology education in high school, prior exposure to genetics, and family history of genetic disorders.

2. Genetic/genomic knowledge [21] to assess public understanding of genetic concepts, including the nature of genetic information, the relationship between gene mutations and disease, and the implications of genetic testing. It includes structured items that evaluate factual knowledge and misconceptions, enabling researchers to gauge genomic literacy and its influence on health-related decision making. This scale supports informed public engagement in genetic screening and personalized healthcare initiatives.

   The tool comprises 11 items distributed across three domains. The first domain evaluates understanding of the characteristics of genetic information (three items), the second explores the relationship between gene mutations and disease manifestation (three items), and the third assesses knowledge of genetic testing and its implications (five items). Each item follows a response format (“Yes”, “No”,” and “unsure), Yes” assigned one point, “no” or “unsure” is assigned 0 points, and the total score of genetic/genomic knowledge (score range: 0 to 11 points). Higher scores indicate adequate knowledge. In the present sample, this scale showed good internal consistency (Cronbach’s alpha = 0.79), comparable to that reported in previous applications.

3. Health numeracy [9]: This includes a 9-item scale to evaluate the ability to understand and apply numerical health information, including risk comprehension, probability calculations, and graphical data interpretation. Responses were scored as 1 for “Yes” and 0 for “No” or “Unsure,” with a total score range of 0–10. The higher score indicates good health numeracy. Internal consistency in this study was acceptable (Cronbach’s alpha = 0.79).

4. Communicative and critical health literacy scale (CCHL) [22]: This tool assesses an individual's ability to interact with health information. Communicative health literacy focuses on the ability to collect, extract, understand, and communicate health-related information from various sources. Critical health literacy evaluates the participant's capacity to consider the credibility of information and make informed decisions regarding health issues. This section used a Likert scale (from “Strongly disagree” to “Strongly agree”) with “strongly agree” (5 points) as the highest and “strongly disagree” (1 point) as the lowest. The total score of the CCHL scale is considered the “CCHL score” (score range: 5—25 points). The highest score indicates proper communicative and critical health literacy. The CCHL scale demonstrated excellent reliability in this Emirati sample (α = 0.88) consistent with previous studies.

5. Risk and benefit perception [9]. This scale systematically measures how individuals perceive the potential risks and benefits of genetic testing. The risk perception Sect. 5 items, focus on emotional and psychosocial concerns, such as anxiety, family burden, and health impacts. The benefit perception Sect. 5 items, highlight the perceived advantages, including prevention, early detection, informed treatment, and empowerment for personal and family health decisions. Responses to each question were based on a five-point scale, with “strongly agree” (5 points) as the highest and “strongly disagree” (1 point) as the lowest. Higher score indicates positive perception.

6. Genetic testing decision-making [9]. This section presents a hypothetical premarital scenario in which the participant is in their twenties, engaged, and has a family history of a hereditary condition associated with a known risk of genetic transmission to future offspring. The vignette was developed in consultation with public health and genetics experts to provide a clear, comprehensible example of inherited risk that would be recognizable to the Emirati public, while avoiding overly technical detail about specific genes or inheritance patterns. Although the UAE premarital screening program has primarily focused on autosomal recessive and X‑linked conditions, it is embedded within a broader national genomic agenda that increasingly encompasses a spectrum of inherited disorders; the vignette was therefore intended to reflect a generic but clinically meaningful scenario in which individuals must decide whether to undergo genetic testing and whether to share positive results with relatives using five-point scale from “Definitely will take the test, score 5” to “Definitely will not take the test, score 1. Vignette‑based methods have been widely used in genomic decision‑making research to elicit intentions in ethically sensitive contexts, and they allow standardized presentation of complex scenarios to all participants.

The tools were reviewed for content and cultural relevance by a panel of three public health and genetic experts.

A pilot test was conducted with 30 Emirati adults from the target population to evaluate clarity, cultural appropriateness, and estimate the administration time. A few items were refined following pilot feedback to enhance linguistic clarity.

Ethical considerations

Ethical approval was obtained from the Ministry of Health and Prevention Research and Ethical Committee (reference number: MOHAP/REC/2025/24–2025-UG-N). Before the participants were asked to complete the survey, brief information about the aim and objectives of the research was presented, the voluntary nature of the survey, the participants’ absolute right to refuse to answer the survey questionnaire at any time, and the confidentiality of the data were also emphasized. Informed consent was obtained in writing before data collection. The survey took an average of 8 to 13 min to complete for each participant. The overall research design and study flow are illustrated in Fig. 2.

Fig. 2.

Diagram of research design

Data analysis plan

Data analysis was conducted using SPSS version 26. Descriptive statistics summarized categorical variables as frequencies and percentages, and continuous variables as means and standard deviations after confirming normality assumptions. Differences in genomic literacy and perception domains across demographic and experiential subgroups were assessed using independent samples t-tests and one‑way ANOVA to explore potential moderating influences. Additionally, multivariate regression models were adjusted for significant demographic variables to account for possible moderation effects at the subgroup level.

Pearson correlation coefficients were used to examine the bivariate relationships among genomic literacy domains, perceptions and behavioral intentions related to genetic testing. Multivariate linear regression models were used to assess the predictive contributions of genomic literacy elements on the intention to undergo genetic testing and disclose results to partners and children. Statistical significance was set at p < 0.05.

Results

A total of 300 Emirati adults participated in the study (82.3% female; mean age = 27.8 ± 8.4 years). Most participants were married (86.4%) and held at least a high school education (47.7%). Approximately 42% worked in healthcare-related fields, and 91% reported prior exposure to biology education in high school.

Table 1 shows that health numeracy and communicative and critical health literacy varied significantly by age, with respondents aged 40–59 years demonstrating the highest scores (p < 0.001). Marital status and having children were associated with higher numeracy and communicative literacy, as well as more positive risk and benefit perceptions (p values ranging from 0.001 to 0.047), suggesting greater engagement with health information among individuals with family responsibilities. Educational attainment, healthcare‑related occupation, prior biology education, and learning about genetics were also linked to higher numeracy and communicative literacy, while participants with a family history of genetic disease reported lower communicative literacy but higher benefit perception, reflecting the complex influence of personal experience on literacy and attitudes.

Table 1.

Comparison of components of genetic literacy by personal characteristics

Personnel characteristics	Variables	Frequency (%)	Genetic/Genomic knowledge	Health Numeracy	Communicative and critical Health Literacy	Risk Perception for Genetic Testing	Benefits Perception for Genetic Testing
Gender	Male	53 (17.7%)	14.50 ± 5.76	5.43 ± 2.27	15.86 ± 4.51	9.28 ± 1.95	13.52 ± 3.85
	Female	247(82.3%)	13.09 ± 5.28	5.25 ± 1.75	16.79 ± 5.23	9.54 ± 2.74	14.83 ± 3.83
			1.64 (0.084)	0.539 (0.592)	1.32 (0.190)	0.810(0.420)	2.23(0.028)*
Age group	20–30	281(93.7%)	13.40 ± 5.49	5.38 ± 1.80	16.82 ± 5.12	9.48 ± 2.622	14.64 ± 3.93
	30–40	16 (5.3%)	11.81 ± 3.39	3.31 ± 1.66	12.43 ± 3.05	9.87 ± 2.96	14.50 ± 2.42
	40–59	3(1.0%)	16.00 ±.00	7.00 ±.00	21.00 ±.000	9.00 ±.00	11.00 ±.00
			1.02 (0.359)	11.4(0.000)**	6.92 (0.001)**	0.224(0.799)	1.33 (0.226)
Marital status	Unmarried	33 (11.0%)	12.06 ± 4.78	4.96 ± 1.89	16.57 ± 5.61	10.12 ± 2.38	15.96 ± 3.68
	Married	259(86.4%)	13.56 ± 5.52	5.39 ± 1.80	16.78 ± 5.05	9.46 ± 2.65	14.47 ± 3.89
	Divorced	4 (1.3%)	12.00 ±.00	5.00 ±.00	15.00 ±.00	10.00 ±.00	11.00 ±.00
	Widowed	4 (1.3%)	11.00 ±.00	1.00 ±.00	9.00 ±.00	6.00 ±.00	15.00 ±.00
			1.10 (0.346)	8.33(0.000)**	3.24 (0.022)*	3.11(0.027)*	2.68(0.047)*
Children	Yes	272(90.7%)	13.55 ± 5.30	5.41 ± 1.83	16.40 ± 5.12	9.41 ± 2.62	14.56 ± 3.82
	No	28 (9.3%)	11.35 ± 5.93	4.00 ± 1.610	18.89 ± 4.62	10.25 ± 2.50	14. ± 4.27
			1.88 (0.069)	4.38(0.000)**	2.68 (0.011)*	1.66 (0.105)	0.474(0.639)
Level of education	High School	143(47.7%)	13.91 ± 5.54	5.55 ± 1.67	16.41 ± 5.28	9.34 ± 2.08	14.39 ± 3.40
	Graduate	144(48.0%)	12.85 ± 5.22	5.02 ± 2.01	17.11 ± 4.62	9.81 ± 3.07	15.32 ± 3.71
	Postgraduate	13 (4.3%)	12.53 ± 5.20	5.30 ± 1.65	13.61 ± 7.43	7.69 ± 1.65	8.92 ± 5.36
			1.55 (0.214)	2.17 (0.052)*	3.06 (0.048)*	4.45(0.012)*	18.76(0.000)**
Occupation	Health care provider	126 (42.0%)	13.12 ± 5.89	4.86 ± 1.96	16.40 ± 5.38	9.48 ± 2.92	14.15 ± 4.09
	Non-health care provider	174 (58.0%)	13.50 ± 5.00	5.59 ± 1.72	16.79 ± 4.92	9.50 ± 2.39	14.93 ± 3.66
			0.584 (0.559)	3.33 (0.001)**	0.648 (518)	0.068 (0946)	1.70 (0.090)
Biology during high school	Completed	273 (91.0%)	13.50 ± 5.36	5.37 ± 1.88	16.64 ± 5.16	9.49 ± 2.57	14.60 ± 3.80
	Not- completed	27 (9.0%)	11.77 ± 5.54	4.4 ± 1.33	16.48 ± 4.75	9.51 ± 3.10	14.55 ± 4.51
			1.54 (0.133)	3.43 (0.001)**	0.173 (0.864)	0.039 (0.969)	0.058 (0.954)
Learned about genetics	Yes	259 (86.3%)	13.45 ± 5.36	5.40 ± 1.86	16.49 ± 5.11	9.39 ± 2.48	14.52 ± 3.76
	No	41 (13.7%)	12.63 ± 5.55	4.53 ± 1.64	17.48 ± 5.13	10.12 ± 3.36	15.09 ± 4.44
			0.888 (0.378)	3.08 (0.003)*	1.14 (0.256)	1.32 (0192)	0.782 (0.438)
Presence of a genetic disease	Yes	170 (56.7%)	13.69 ± 5.67	5.16 ± 1.75	14.56 ± 5.36	9.20 ± 2.76	13.40 ± 4.01
	No	130 (43.3%)	13.08 ± 5.16	5.37 ± 1.93	18.21 ± 4.31	9.71 ± 2.50	15.52 ± 3.49
			0.959 (0.339)	0.970 (0.333)	6.32 (0.000)**	1.65 (0.096)	4.8 (0.000)**

^*p < 0.05

^**p < 0.01

Table 2 summarizes Pearson correlations among genomic literacy variables. Genetic/genomic knowledge was positively correlated with health numeracy (r = 0.14, p = 0.012) and risk perception (r = 0.13, p = 0.020). Health numeracy strongly correlated with communicative and critical literacy (r = 0.35, p < 0.001), and the latter showed strong associations with both risk (r = 0.20, p = 0.001) and benefit perception (r = 0.47, p < 0.001). Risk and benefit perceptions were moderately interrelated (r = 0.42, p < 0.001).

Table 2.

Correlation between components of genetic literacy

Variables	Statistical test	Genetic/Genomic knowledge	Health Numeracy	Communicative and critical Health Literacy	Risk Perception for Genetic Testing	Benefits Perception for Genetic Testing
Genetic/Genomic knowledge	Pearson Correlation	1	.144*	-.021	.134*	.024
	Sig. (2-tailed)		.012	.713	.020	.684
Health Numeracy	Pearson Correlation	.144*	1	.354**	-.067	.070
	Sig. (2-tailed)	.012		.000	.247	.224
Communicative and critical Health Literacy	Pearson Correlation	-.021	.354**	1	.196**	.466**
	Sig. (2-tailed)	.713	.000		.001	.000
Risk Perception for Genetic Testing	Pearson Correlation	.134*	-.067	.196**	1	.423**
	Sig. (2-tailed)	.020	.247	.001		.000
Benefits Perception for Genetic Testing	Pearson Correlation	.024	.070	.466**	.423**	1
	Sig. (2-tailed)	.684	.224	.000	.000

^*p < 0.05

^**p < 0.01

^***p < 0.001

Table 3 examines how the components of genetic literacy are linked to behavioral intentions regarding genetic testing and result disclosure. The intentions to undergo genetic testing was significantly correlated with communicative and critical health literacy (r = 0.257, p < 0.001), suggesting that individuals who can critically evaluate health information are more inclined to pursue testing. Disclosure intentions also showed strong associations with the other variables. The intention to inform a partner about positive results was correlated with health numeracy (r = 0.203, p < 0.001), communicative literacy (r = 0.269, p < 0.001), and benefit perception (r = 0.243, p < 0.001), indicating that disclosure to intimate partners is influenced by both cognitive competencies and recognition of the test’s value. Similarly, the intention to inform children was correlated with all literacy components, most strongly with communicative literacy (r = 0.214, p < 0.001), as well as with genetic knowledge (r = 0.159, p = 0.006), health numeracy (r = 0.210, p < 0.001), and benefit perception (r = 0.150, p = 0.009) respectively. These findings underscore the multidimensional role of literacy in shaping the intergenerational communication of genetic information.

Table 3.

Correlation between intentions and components of genetic literacy

Variables	Statistical test	Genetic/Genomic knowledge	Health Numeracy	Communicative and critical Health Literacy	Risk Perception for Genetic Testing	Benefits Perception for Genetic Testing
One’s intention toward genetic testing	Pearson Correlation	.050	.135*	.257**	.099	.039
	Sig. (2-tailed)	.392	.019	.000	.087	.505
Intention to convey positive results to my partner	Pearson Correlation	.080	.203**	.269**	.092	.243**
	Sig. (2-tailed)	.166	.000	.000	.112	.000
Intention to convey positive results to your children	Pearson Correlation	.159**	.210**	.214**	.136*	.150**
	Sig. (2-tailed)	.006	.000	.000	.019	.009

^*p < 0.05

^**p < 0.01

The regression analyses summarized in Table 4 illustrate the multivariate relationships between behavioral intentions and the components of genetic literacy. For the intention to undergo genetic testing, communicative and critical health literacy was the most influential positive predictor (β = 0.290, p < 0.001), while benefit perception was negatively associated (β = −0.143, p = 0.038), possibly reflecting that some individuals with high benefit perception feel sufficiently reassured and thus are less motivated to personally seek testing. The explained variance for this model was notable (R² = 0.295), although the adjusted R² was somewhat lower (0.071), indicating moderate predictive power after accounting for model complexity.

Table 4.

Multiple regression analysis with behavioral intentions and components of genetic literacy

Behavioral intentions	Variables	Standardized partial regression coefficient	P-value	95%CI
One’s intention toward genetic testing	Genetic/Genomic knowledge	.039	.492	[-.014,.030]
	Health Numeracy	.043	.481	[-.044,.093]
	Communicative and critical Health Literacy	.290	.000*	[.032,.087]
	Risk Perception for Genetic Testing	.100	.112	[-.009,.089]
	Benefits Perception for Genetic Testing	-.143	.038	[-.075, −002]
	R2	0.295	0.000***
	Adjusted R2	0.071
Intention to convey positive results to my partner	Genetic/Genomic knowledge	.012	.276	[-.011,.038]
	Health Numeracy	.038	.034	[.006,.156]
	Communicative and critical Health Literacy	.015	.028	[.004,.064]
	Risk Perception for Genetic Testing	.028	.905	[-.057,.051]
	Benefits Perception for Genetic Testing	.020	.014	[.010,.090]
	R2	0.333	0.000*
	Adjusted R2	0.096
Intention to convey positive results to your children	Genetic/Genomic knowledge	.128	.026	[.003,.052]
	Health Numeracy	.149	.015	[.018,.170]
	Communicative and critical Health Literacy	.128	.060	[-.001,.060]
	Risk Perception for Genetic Testing	.086	.168	[-.016,.093]
	Benefits Perception for Genetic Testing	.041	.549	[-.028,.053]
	R2	0.311	0.00**
	Adjusted R2	0.081

CI Confidence Interval

^*p < 0.05

^**p < 0.01

^***p < 0.001

Intentions to share positive results with a partner were significantly predicted by higher health numeracy (β = 0.038, p = 0.034), communicative and critical health literacy (β = 0.015, p = 0.028), and benefit perception (β = 0.020, p = 0.014), highlighting the importance of both cognitive and appraisal components, although the explained variance was modest (R² = 0.333; adjusted R² = 0.096). For the intention to share with children, genetic/genomic knowledge (β = 0.128, p = 0.026) and health numeracy (β = 0.149, p = 0.015) were significant positive predictors, underscoring the value of both factual understanding and numeracy in motivating parental health communication. The model's explanatory capacity remained moderate (R² = 0.311; adjusted R² = 0.081). Collectively, these findings position communicative and critical health literacy, as well as numeracy and factual understanding, as key drivers of both testing intentions and willingness to disclose results within families.

Discussion

This study assessed the influence of genomic literacy components: functional, interactive, and critical health literacy on risk and benefit perceptions and intentions related to genetic testing among Emirati adults. Findings demonstrated that communicative (interactive) and critical literacy were the strongest predictors of intention to undergo genetic testing, with benefit perception also playing a significant role. Functional literacy showed a positive but smaller effect. Risk perception was associated with intentions but was not a significant independent predictor in multivariate analyses. These results align with the study objectives to understand cognitive and attitudinal drivers of genomic decision-making within the UAE’s sociocultural landscape.

The present study revealed a moderate level of genomic knowledge among Emirati participants which is consistent with various studies indicating that individuals with higher genomic knowledge tend to hold more favorable attitudes and show greater intention to undergo testing; Miyoshi and Watanabe [9] reported that enhanced knowledge improves benefit perception, which in turn increases the intention to test among the Japanese public while Jaeger et al. [23] showed that both actual and perceived knowledge predict engagement in testing behaviors among the public in the USA. Alotaibi et al. [24] observed that a score meeting or exceeding 60% on their genetic knowledge instrument strongly correlates with positive attitudes (p ≤ 0.001) among peoples from various Saudi Arabian regions. In contrast, Haga et al. [25] noted that an imbalance of knowledge between scientific and medical concepts related to genetics and between the medical applications and societal consequences of testing. They also found that while increased knowledge promotes willingness to undergo testing, it can also lead to anxiety or hesitation, especially if individuals recognize the possible psychological or ethical ramifications of receiving genetic information. The slight gender difference observed in the current study, where females displayed marginally lower factual genetic knowledge but higher communicative and critical health literacy, parallels studies [26],Kaphingst et al., [27] pointing to gender-related variances in health education uptake and cognitive processing. These discrepancies suggest women may rely more on experiential and interpersonal information channels, underscoring the importance of tailored educational materials sensitive to gendered learning preferences.

Health numeracy and literacy are essential for rational risk–benefit appraisal and effective use of genetic information. Strong correlations between health numeracy and interactive literacy components were observed in this study. This agrees with Miyoshi and Watanabe [9], who found that interactive and critical health literacy contributes to better appraisal of genetic information. Health numeracy and communicative literacy levels demonstrated significant variations with demographic factors such as age, marital status, and parenthood. This finding is consistent with Alsafar et al., [26] and Kaphingst et al., [27] who reported that older age, marital status, higher educational attainment, and professional backgrounds in healthcare or biology were all associated with improved numeracy and communicative literacy, critical appraisal skills, reflecting the worldwide pattern that formal training improves essential competencies for interpreting genomic information. The slight decline in literacy with increasing age among older participants may reflect generational educational differences, which is an important consideration for designing age-appropriate genomic education strategies in the UAE.

Cultural factors emerge as important in Middle Eastern contexts, where family history and consanguinity shape attitudes and drive uptake of testing, as illustrated by findings from studies in Saudi Arabia, Qatar, Jordan and the United Arab Emirates [24, 26, 28–30]. Krakow [31] conducted a study to assess genetic literacy awareness and knowledge gaps in the US population and that found, 20.95% of participants aware of genetic testing actually used it, and another study reported a 71% willingness to participate related to basic genetics literacy. Together, the evidence shows that higher genomic literacy is generally associated with more positive perceptions and greater engagement in genetic testing decisions [9]. Interactive and critical health literacy showed strong positive correlations with risk and benefit perception, meaning that individuals who can access, interpret, and critique health information more confidently form realistic appraisals of advantages and limitations of genetic testing.

Furthermore, Regression analyses in the current study confirm that communicative and critical health literacy significantly predicted the intention to undergo genetic testing, surpassing genomic knowledge alone. Numeracy and factual understanding were key for intentions to disclose results within families. Communicative and critical health literacy, consistent with Nutbeam’s interactive and critical domains, emerged as pivotal predictors of informed genetic testing decisions. These findings reinforce that health literacy comprises multiple competencies essential for engaging with genomic technologies [17]. This aligns with studies on the vital role of analytic competencies in health communication [27, 31]. In contrast, an unexpected finding in this study was the negative association between perceived benefits of genetic testing and intention to undergo testing in the multivariable model. One possible explanation is a reassurance effect, whereby individuals who strongly endorse the general benefits of genetic testing may feel that they or their families are already sufficiently protected by existing screening programmes and health services, thereby perceiving less urgency for personal testing. In the Emirati context, decisions about premarital and family health are often made collectively and informed by religious beliefs, trust in God, and the council of elders or healthcare professionals; individuals who see high potential benefit at a societal or familial level may therefore defer individual testing until family consensus is reached or a clinician recommends it. Optimism bias and reliance on divine providence may also contribute to a pattern in which high perceived benefit does not automatically translate into immediate personal action. The demographic patterns observed particularly higher literacy and benefit perception among married participants, parents, and those with prior genetics exposure suggest that life stage and experience may further shape how benefits are construed and how quickly individuals move from appreciation of benefits to concrete testing decisions.

Strengths and limitations

A key strength of this study is its comprehensive multidimensional assessment of genomic literacy within a representative Emirati cohort, enriching understanding in a largely under-researched population. Robust statistical analyses provide credible insights into predictors of genetic testing decision-making. Several limitations should be acknowledged. First, the outcomes assessed in this study were self‑reported behavioral intentions to undergo genetic testing and to disclose positive results to family members, rather than objectively measured testing or disclosure behaviors; intentions may be influenced by social desirability and may not fully predict actual uptake, underscoring the need for longitudinal studies that track decisions and actions over time. Second, the cross‑sectional design precludes causal inference regarding the directionality of relationships between genomic literacy, perceptions, and behavioral intentions. Third, the use of convenience sampling rather than a proportionate or probability‑based sampling strategy across community strata, may have introduced selection bias and limits the generalizability of the findings to the broader Emirati population; future studies should employ proportionate or stratified sampling frames to obtain more representative estimates of genomic literacy and genetic testing intentions. An additional limitation concerns the use of a single hypothetical vignette to elicit intentions regarding genetic testing and result disclosure. Future research should consider employing multiple vignettes representing different inheritance patterns, disease severities, and counselling contexts, as well as qualitative interviews, to more fully explore how Emirati adults interpret premarital screening results and negotiate testing and disclosure decisions. Finally, although we examined demographic and experiential differences in literacy and perceptions, further work is needed to model more complex interactions between sociocultural factors, psychological constructs, and structural determinants that may influence genetic testing decisions. Future research using qualitative and longitudinal designs is needed to disentangle the sociocultural dynamics and to clarify how benefit perceptions evolve from abstract endorsement to actual uptake of testing over time.

Implications for public health education and policy

These findings advocate for multi-layered public health education strategies in the UAE, prioritizing not only knowledge dissemination but also enhancement of numeracy and critical appraisal skills to enable informed and confident decision-making regarding genetic testing. Interventions should incorporate culturally tailored communication frameworks accounting for gender and demographic disparities. These findings support the integration of genomic literacy not only within nursing curricula but across the education and continuing professional development of physicians, genetic counsellors, midwives, and allied health professionals who contribute to premarital screening, reproductive counselling, and chronic disease management in the UAE. Inter‑professional training that combines case‑based learning, simulation, and communication skills practice can enable healthcare teams to jointly support individuals and families in navigating genetic testing decisions and familial disclosure. Policy frameworks must emphasize genetic counseling services and literacy-sensitive health communication to maximize equitable access and utilization of genomic technologies. Regional adaptation of global health literacy models will be essential to accommodate sociocultural nuances.

Recommendations and future directions

Targeted educational interventions integrating numeracy and communicative skills training, delivered through interactive community health programs, are recommended to bridge genomic literacy gaps. Healthcare providers should be equipped with tools to facilitate informed consent and familial disclosure. Research priorities include exploring barriers to literacy uptake in vulnerable groups and evaluating longitudinal impacts on genetic testing behaviors. Expanding genomic literacy initiatives across the Middle East could potentiate personalized medicine and preventive health strategies regionally. These strategies are essential to foster informed decision-making and optimize the uptake of genomic technologies in the UAE and similar sociocultural contexts.

Conclusion

This study underscores the pivotal role of genomic literacy—particularly communicative and critical health literacy, health numeracy, and factual genomic knowledge—in shaping Emirati adults’ intentions and attitudes toward genetic testing. While genomic knowledge alone showed limited predictive power, interactive and appraisal-based competencies significantly influenced both testing decisions and familial disclosure behaviors. Demographic factors such as age, marital status, education, and professional background further modulated literacy levels and perceptions. The findings advocate that public health campaigns should incorporate interactive workshops and digital tools that simulate genetic risk scenarios to enhance critical appraisal skills. Nursing curricula should include modules on ethical communication of genetic information tailored to Emirati cultural values. Future research should explore longitudinal impacts of literacy-enhancing interventions and advocate for policy frameworks that institutionalize genomic literacy promotion as a public health priority worldwide.

Authors’ contributions

R.G.A conceptualize the study and drafted the initial proposal. R.S was involved in data validation and analysis. B.M, T.A.S., S. G., A. M.S, N. E. M., R. B, L, L. D. were involved in data collection and data validation. R.G.A, R.S & B.M were involved in reviewing, editing and revising. All approved the final manuscript, and also agree to be accountable for all aspects of the work.

Funding

This research did not receive any external funding.

Data availability

Data supporting the findings are available in the study.

Declarations

Ethics approval and consent to participate

Written informed consent was obtained from all subjects involved in the study.

Consent for publication

Not applicable.

Competing interests

The authors declare no competing interests.