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Abstract
<title>Abstract</title> <p>Background National precision medicine initiatives require public understanding of probabilistic genetic risk, yet populations are heterogeneous in knowledge, confidence, and attitudes. Simple demographic segmentation may miss complex patterns shaping engagement with genomic information. This study applied latent class analysis (LCA) to identify genetic literacy profiles among participants in a national genomics program, focusing on knowledge-confidence alignment. Methods A cross-sectional survey of 509 Emirati adults (aged 18–64) was conducted in Abu Dhabi from January 20 to February 3, 2025. LCA used indicators of objective genetic knowledge (four true/false items assessing penetrance, probabilistic risk, gene-environment interaction, and heritability), self-perceived knowledge, demographics, program participation, and attitudinal variables, including worry about results and willingness to change lifestyle. Results LCA identified 10 classes with different configurations of knowledge, confidence, and engagement. The most striking finding was systematic misalignment between knowledge and confidence. Class 2 (8.4%) (highly educated, engaged, middle-aged male professionals) demonstrated the lowest objective knowledge (16.5% correct) despite high self-reported confidence. Conversely, Class 8 (10.5%), middle-aged women with chronic disease and lower education, demonstrated high objective knowledge (58.5%), potentially driven by personal health experience. The largest class (Class 5, 22.6%) comprised knowledgeable, engaged middle-aged adults. Conclusions Genetic literacy is not distributed along simple demographic lines. LCA reveals that knowledge, confidence, and engagement combine in complex patterns conventional demographic targeting cannot capture. Identifying "confident but uninformed" profiles has direct implications for how precision medicine programs design education and communicate results. Different profiles require different interventions: confidence-building for the knowledgeable but worried, misconception correction for the confident but uninformed.</p>