Voices in practice: Exploring genetic counseling ethical, cultural, social, and religious dynamics in the UAE

Genetic counseling is expanding globally, yet remains underexplored in Middle Eastern contexts. In the United Arab Emirates (UAE), rapid biomedical advancements intersect with traditional sociocultural and religious norms, presenting unique contexts for clinical practice. This study explored the perspectives of genetic counselors and clinical geneticists to identify key sociocultural, ethical, and systemic factors influencing genetic counseling in the UAE. Guided by a constructivist-interpretivist paradigm, we conducted semi-structured interviews, generating a dataset from 11 professionals (seven genetic counselors, four clinical geneticists) practicing in the UAE between January and August 2024. Data were analyzed using Braun and Clarke's reflexive thematic analysis, reported in accordance with RTARG guidelines. The analysis was predominantly inductive, while the Consolidated Framework for Implementation Research (CFIR) was used deductively as a sensitizing framework for themes relating to institutional and systemic influences. Four major themes were constructed: (1) Social and cultural dynamics, including stigma, limited genetic literacy, and family-centered decision-making, influenced engagement and consent; (2) Religious perspectives: faith offered resilience but at times fostered fatalism that limited intervention; (3) Ethical considerations: autonomy, confidentiality, and informed consent were negotiated within collectivist family structures; and (4) Systemic factors, including limited interprofessional coordination, the need for UAE-specific training and time constraints. The Emirati Genome Program was described as a facilitator of awareness and management. Participants emphasized the need for culturally responsive, semi-directive counseling approaches, enhanced consent processes, and targeted community education. Our interpretive analysis underscores the need for culturally responsive, semi-directive counseling approaches that balance respect for autonomy with relational guidance. These insights provide a framework for strengthening practice, training, and policy in the UAE and may be applicable across Gulf and MENA healthcare systems with similar sociocultural dynamics.