For those wishing to assess their reproductive risks and make informed decisions in their reproductive planning, carrier screening for autosomal recessive and X-linked conditions, as well as cell-free DNA (cfDNA) screening for aneuploidy, are recommended during pregnancy. Despite similarities in purpose, sample requirements, insurance coverage, and safety, a lower percentage of individuals elect carrier screening than cfDNA screening, suggesting there may be a disconnect in what patients perceive as valuable information for their pregnancy. Previous studies have attempted to explain the factors associated with carrier screening uptake or decline; however, no models have yet accounted for a patient’s literacy level in health, genetics, and science. Thus, this study aimed to establish rates of these literacies in a prenatal population and determine whether these literacies were related to carrier screening uptake or informed decision-making. Patients receiving care at UTHealth prenatal clinics were offered a survey following standardized carrier screening education consisting of a demographics questionnaire, a modified Multivariate Measure of Informed Choice (mMMIC), and three validated tools each assessing a different literacy: a single question assessing health literacy, the Genetic Literacy and Comprehension (GLAC) measure, and a survey developed by Pew Research to measure scientific literacy. Testing decisions were confirmed via chart review. Health, genetic, and scientific literacy was identified at a rate of 91%, 69%, and 23%, respectively. Carrier screening uptake was 67% in primigravida patients compared to 91% for cfDNA screening and was not found to be associated with literacy. However, informed choice regarding carrier screening (14.7%) was associated with both genetic (MdnI = 14.75, MdnU = 11.33; p < 0.001) and scientific literacy (MdnI = 10.5, MdnU = 4; p < 0.001) as well as with income, education level, and type of insurance coverage (p < 0.001 for all). This study illustrates that higher rates of scientific and genetic literacy, as well as socioeconomic factors, are associated with informed carrier screening decision-making.
","abstract_html":"<p>For those wishing to assess their reproductive risks and make informed decisions in their reproductive planning, carrier screening for autosomal recessive and X-linked conditions, as well as cell-free DNA (cfDNA) screening for aneuploidy, are recommended during pregnancy. Despite similarities in purpose, sample requirements, insurance coverage, and safety, a lower percentage of individuals elect carrier screening than cfDNA screening, suggesting there may be a disconnect in what patients perceive as valuable information for their pregnancy. Previous studies have attempted to explain the factors associated with carrier screening uptake or decline; however, no models have yet accounted for a patient’s literacy level in health, genetics, and science. Thus, this study aimed to establish rates of these literacies in a prenatal population and determine whether these literacies were related to carrier screening uptake or informed decision-making. Patients receiving care at UTHealth prenatal clinics were offered a survey following standardized carrier screening education consisting of a demographics questionnaire, a modified Multivariate Measure of Informed Choice (mMMIC), and three validated tools each assessing a different literacy: a single question assessing health literacy, the Genetic Literacy and Comprehension (GLAC) measure, and a survey developed by Pew Research to measure scientific literacy. Testing decisions were confirmed via chart review. Health, genetic, and scientific literacy was identified at a rate of 91%, 69%, and 23%, respectively. Carrier screening uptake was 67% in primigravida patients compared to 91% for cfDNA screening and was not found to be associated with literacy. However, informed choice regarding carrier screening (14.7%) was associated with both genetic (<em>Mdn<sub>I</sub></em> = 14.75, <em>Mdn<sub>U</sub></em> = 11.33; <em>p</em> < 0.001) and scientific literacy (<em>Mdn<sub>I</sub></em> = 10.5, <em>Mdn<sub>U</sub></em> = 4; <em>p</em> < 0.001) as well as with income, education level, and type of insurance coverage (<em>p</em> < 0.001 for all). This study illustrates that higher rates of scientific and genetic literacy, as well as socioeconomic factors, are associated with informed carrier screening decision-making.</p>","abstract_has_math":false,"creators":["Albracht, Brenna D","0009-0001-9451-1252
"],"institution":null,"degree_name":"Masters of Science (MS)","degree_level":"Thesis (MS)","degree_discipline":null,"degree_department":null,"school":null,"contributors":["Meagan Choates, MS, CGC","Myla Ashfaq, MS, CGC","Jacqueline Harkenrider, MS, CGC"],"advisors":[],"committee_chairs":[],"committee_members":[],"year":2025,"date_issued":"2025-05-01T07:00:00Z","date_published":"2025-05-01T07:00:00Z","updated_at":"2026-07-24T05:49:08Z","subjects":["genetic counseling","carrier screening","informed choice","scientific literacy","health literacy","genetic literacy","sociodemographic factor","decision making","genetic testing","pretest education","Genetics","Maternal and Child Health","Obstetrics and Gynecology","Other Genetics and Genomics"],"languages":[],"rights":[],"rights_urls":[],"identifier_entries":[]},"links":{"outbound_url":"https://digitalcommons.library.tmc.edu/utgsbs_dissertations/1438","outbound_label":"Repository record","outbound_source":"dc:identifier"},"metadata_groups":[{"id":"people","label":"People","entries":[{"key":"dc:contributor","label":"Contributor","values":["Meagan Choates, MS, CGC","Myla Ashfaq, MS, CGC","Jacqueline Harkenrider, MS, CGC"]},{"key":"dc:creator","label":"Author","values":["Albracht, Brenna D","0009-0001-9451-1252
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"]},{"key":"dc:title","label":"Title","values":["The Influence of Scientific, Genetic, and Health Literacy on Carrier Screening Decision-Making"]}]}],"canonical_facts":{"dc:contributor":["Meagan Choates, MS, CGC","Myla Ashfaq, MS, CGC","Jacqueline Harkenrider, MS, CGC"],"dc:creator":["Albracht, Brenna D","0009-0001-9451-1252
"],"dc:date.available":["2026-04-30T07:00:00Z"],"dc:description.abstract":["For those wishing to assess their reproductive risks and make informed decisions in their reproductive planning, carrier screening for autosomal recessive and X-linked conditions, as well as cell-free DNA (cfDNA) screening for aneuploidy, are recommended during pregnancy. Despite similarities in purpose, sample requirements, insurance coverage, and safety, a lower percentage of individuals elect carrier screening than cfDNA screening, suggesting there may be a disconnect in what patients perceive as valuable information for their pregnancy. Previous studies have attempted to explain the factors associated with carrier screening uptake or decline; however, no models have yet accounted for a patient’s literacy level in health, genetics, and science. Thus, this study aimed to establish rates of these literacies in a prenatal population and determine whether these literacies were related to carrier screening uptake or informed decision-making. Patients receiving care at UTHealth prenatal clinics were offered a survey following standardized carrier screening education consisting of a demographics questionnaire, a modified Multivariate Measure of Informed Choice (mMMIC), and three validated tools each assessing a different literacy: a single question assessing health literacy, the Genetic Literacy and Comprehension (GLAC) measure, and a survey developed by Pew Research to measure scientific literacy. Testing decisions were confirmed via chart review. Health, genetic, and scientific literacy was identified at a rate of 91%, 69%, and 23%, respectively. Carrier screening uptake was 67% in primigravida patients compared to 91% for cfDNA screening and was not found to be associated with literacy. However, informed choice regarding carrier screening (14.7%) was associated with both genetic (MdnI = 14.75, MdnU = 11.33; p < 0.001) and scientific literacy (MdnI = 10.5, MdnU = 4; p < 0.001) as well as with income, education level, and type of insurance coverage (p < 0.001 for all). This study illustrates that higher rates of scientific and genetic literacy, as well as socioeconomic factors, are associated with informed carrier screening decision-making.
"],"dc:identifier":["https://digitalcommons.library.tmc.edu/utgsbs_dissertations/1438"],"dc:subject":["genetic counseling","carrier screening","informed choice","scientific literacy","health literacy","genetic literacy","sociodemographic factor","decision making","genetic testing","pretest education","Genetics","Maternal and Child Health","Obstetrics and Gynecology","Other Genetics and Genomics"],"dc:title":["The Influence of Scientific, Genetic, and Health Literacy on Carrier Screening Decision-Making"],"thesis:degree_level":["Thesis (MS)"],"thesis:degree_name":["Masters of Science (MS)"]},"updated_at":"2026-07-24T05:49:08Z"}