Knowledge, Attitudes, Religiosity, and Reproductive Genetic Carrier Screening: A Cross-Sectional Study

Background/Objectives: Reproductive genetic carrier screening for autosomal recessive and X-linked conditions is an important component of preconception care, yet uptake may be influenced by informational, attitudinal, cultural, and religious factors. Few studies have examined genetic knowledge, attitudes, and religiosity jointly in relation to self-reported carrier-screening behavior. This study characterized previous carrier screening, perceived barriers, decision influences, and preferred consultation sources among adults in Israel and assessed the independent contributions of these psychosocial factors beyond sociodemographic characteristics and reproductive life stage. Methods: A cross-sectional online survey was completed by 331 adults aged 18-60 years. The questionnaire introduction defined the study context as genetic carrier screening; subsequent abbreviated references to genetic testing were intended to refer to carrier screening within that frame. Measures assessed self-reported previous carrier screening, genetic knowledge, attitudes, religiosity, perceived barriers, and preferred consultation sources. Descriptive, bivariate, and hierarchical binary logistic regression analyses were conducted. Results: Overall, 37% reported previous genetic carrier screening. The leading perceived barriers were fear of results (66%) and insufficient knowledge of carrier screening's purpose (61%). Physicians were the most frequently reported decision influence (62%) and preferred consultation source (80%). The final combined hierarchical logistic regression model was significant relative to the intercept-only model, χ²(10) = 131.25, p < 0.001, with a Nagelkerke R² of 0.455. More favorable attitudes were associated with higher odds of previous carrier screening (OR = 4.329, 95% CI [2.369, 7.909]), whereas participants without children at the time of the survey had lower odds than those with children (OR = 0.080, 95% CI [0.031, 0.202]). Knowledge and religiosity were not independently associated with previous carrier screening after adjustment. Conclusions: A minority of participants reported having previously undergone genetic carrier screening, despite broad recognition of the importance of preconception or premarital screening. Carrier-screening programs may benefit from addressing emotional, informational, cultural, and practical barriers through proactive, culturally responsive, autonomy-supportive clinician communication in preconception and primary-care settings.