Knowledge, attitudes and perceptions of Genomic Medicine among medical students, private medical practitioners and the general public in eThekwini, KwaZulu-Natal

Abstract

The use of genomics in public health has the potential to contribute towards the diagnoses of diseases, ensuring the efficiency of health promotion interventions and assist in developing more effective pharmaceuticals. Research conducted abroad has documented the discourse of public and medical perceptions towards genetic testing, however, there is a lack of information to inform the health sector within South Africa with respect to the knowledge and attitudes of the general public and medical sector towards genetic testing. Therefore, the aim of this study was to document and evaluate the knowledge, attitudes and perceptions surrounding the use of public health genomic (PHG) medicine. This was a quantitative cross sectional study and our convenient sample included representatives from the general public, medical students and medical practitioners within the eThekwini region in KwaZulu-Natal (n=170). Participants were required to fill out administered questionnaires which included likert scale questions. Medical practitioners from both private and public health sector in the KZN region were sampled (n=45). Medical students comprised of second year students from the UKZN Nelson R Mandela medical school who had not yet been exposed to the genetic module in their medical curriculum (n=79). Representatives of the general public included educators from private and public primary schools in Durban and surrounding areas (n=46). Descriptive and frequency analysis using mean, standard deviation and range was used for quantitative variables. Knowledge and attitude responses were stratified by gender, race and for medical practitioners by practice type. Bivariate correlations using Spearman’s rho test and principle component analysis was conducted. Scoring scales were used to determine the level of knowledge and type of attitude among participants towards predictive genetic testing. Results revealed that the knowledge of the general public, medical practitioners and medical students towards the use of public health genomics were adequate. Medical students displayed a negative attitude towards the uptake of predictive genetic testing which was contrary to the positive attitudes of the general public and medical practitioners. Stratification by gender indicated that women from the general public were more accepting of PHG despite the increased costs associated with genetic testing. We found that females were knowledgeable on the primary use of predictive genetic testing, and more Africans (77%) than Indians (46.2%) and Whites (50%) were aware that genetic testing is being offered in South Africa. Results of bivariate correlations revealed that current medical practitioners would still use predictive genetic testing despite the possible ethical, legal, and social implications for the end user. PCA (Principle Component Analysis) confirmed a strong factor loading for a willingness to use predictive genetic testing among the general public. PCA yielded a high factor loading on an awareness for the need for a proper legislative framework for PHG among medical students. Medical students articulated a need for additional training in public health genomics. In order to improve knowledge among the medical fraternity, institutions should adapt undergraduate and post-graduate curriculum to make provision for relevant PHG training that would be extended not only to medical and health care students but offered to qualified practitioners for continuous professional development training. In addition, awareness should be created on various media platforms to inform the public about the availability and costs associated with predictive genetic testing services in South Africa. Relevant stakeholders from both the public and private health sector in South Africa should be aware of the challenges that could impact on the uptake of public health genomics in South Africa, given its potential for use in the NHI (National Health Insurance) structure.