Pharmacogenomics (PGx) is a scientific discipline that merges pharmacology and genomics (Abdela et al., 2017). PGx testing is becoming more and more widely available in healthcare settings, and a growing body of actionable high-level evidence for clinical utility mandates the provision of sustainable PGx education to healthcare professionals. As a component of personalized medicine, PGx uses genetic information to optimize therapeutic benefits, enhance clinical outcomes, and reduce drug adverse reactions (ADR) (Klein et al., 2017; Barker et al., 2022). Thus, PGx can potentially improve the therapeutic strategy of a patient by selecting the appropriate medication at the correct dosage (Verbelen et al., 2017). Although, sub-optimal response to medication along with the presence of ADRs can be partially explained by other factors including sub-dosing, drug allergy, drug-drug interactions, or lack of patient compliance, a person’s genetic makeup remains an important factor to consider (Rollinson et al., 2020). Many clinical studies in adult patients have demonstrated the clinical utility of PGx in drug management (Klein et al., 2017; Verbelen et al., 2017; Swen et al., 2023).

PGx applications have gained momentum in the last decades thanks to the completion of the Whole Genome Sequence and AllOfUs program in the United States, and led to an increased popularity and the launch of other clinical projects such as the Emirati Genome Project in the United Arab Emirates (UAE) (Klein et al., 2017; Al-Ali et al., 2018). Healthcare professionals including physicians, pharmacists, dentists, and nurses are welcoming the PGx concept and are trying to incorporate it into their clinical practice but at a slow pace (Hansen et al., 2022). Their role in PGx clinical application has been thoroughly investigated in many studies (Albassam et al., 2018; Algahtani, 2020; Alhaddad et al., 2022). Indeed, it was shown that healthcare professionals had a rather positive attitude and were willing to adopt it but they lacked the proper knowledge and training along with self-confidence (Abdela et al., 2017; Albassam et al., 2018; Algahtani, 2020; Smith et al., 2020; Albitar and Alchamat, 2021; Alhaddad et al., 2022; Hansen et al., 2022; Hayashi and Bousman, 2022).

Several challenges and barriers impede PGx’s widespread implementation despite the proven clinical and economic effectiveness of PGx (Chenoweth et al., 2020; Koufaki et al., 2021). The lack of healthcare knowledge and training in the field, the high cost of PGx testing, the lack of reimbursement, and moral and bioethical concerns are some examples. This slow PGx adoption rate in clinical practice must change. To do so, future healthcare professionals must receive a proper education in PGx aiming to overcome their concerns and reluctance. There is another publication, by Rahma and coworkers, 2020, about UAE undergraduate and postgraduate students’ attitudes and level of knowledge related to genomics and PGx (Rahma et al., 2020). In contrast to Rahma and coworkers, 2020 study, our project concentrated on undergraduate medical and health science students and it investigates the impact of four different factors in their intention to adopt PGx and not only two (Rahma et al., 2020). In addition, the survey instrument used in this project was developed based on a behavioral theory and not only based on literature.

In this study, we investigated the attitudes, self-confidence, level of knowledge, barriers, and intentions of health sciences undergraduate students from different Colleges of the University of Sharjah (UoS) to adopt PGx applications in clinical practice using a questionnaire developed based on Theory of Planned Behavior (TPB). Our objectives were to evaluate the impact of different factors on students’ intentions and to highlight any correlations or relations among factors.

This study’s results are shown in Tables 2; Figures 1–7. Cronbach analysis was performed. As demonstrated in Table 2 four out of the five factors of this study’s instrument had a Cronbach’s alpha value above 0.8. Only level of knowledge had a Cronbach’s alpha value of 0.509. Given the fact that Cronbach’s alpha coefficient measures the internal consistency of a scale and a coefficient of 0.7 or higher is generally considered acceptable, it is indicated that the overall internal consistency of the questionnaire scale is acceptable. The level of knowledge as a factor is less consistent probably due to the different measuring scales used.

Upon confirming instrument validity, a confirmatory factor analysis was performed, as shown in Tables 3, 4, 5, close to 0.5 indicating that the proposed model has an acceptable fit. However, GFI, NFI, and RFI indexes were close to 0.8 but not close to 0.9, a fact that highlights that the model proposed is not the perfect fit. The model is applied in a highly diverse cohort in terms of nationalities, scientific backgrounds, and years of studies, and thus, having at least a few parameters within acceptable ranges, it can be concluded that the model is of good fit (Doll et al., 1994; Baumgartner and Homburg, 1996).

PGx is an emerging field of personalized medicine that can offer a series of advantages in drug management. Besides the plenty and proven clinical benefits, the adoption rate of PGx applications in clinical practice remains low across the globe. The main way to boost PGx implementation is by investing in having adequately trained future generations of healthcare professionals. For this reason, we aimed to investigate the attitudes, beliefs, and level of knowledge of health science undergraduate students of UoS.

According to our findings, the proposed model had a good internal consistency since four out of five independent factors had a Cronbach α that was over 0.8. The model had also a good fit (CMIN/DF was almost three while RMSEA was found at 0.65), a fact that is highly important since in social studies it is not common to find high consistency scores. In addition, the proposed model managed to fit the multinational and heterogeneous character of the sample, a fact that is also significant. Based on the regression analysis, attitude was the factor with the greatest impact on students’ intentions to adopt PGx which also correlated with barriers and level of knowledge. The level of knowledge did not fit well in the model and had a meaningless impact on students’ intentions. Self-confidence and barriers were shown to contribute to students’ willingness to adopt, while barriers were positively correlated with attitudes as well.

Moreover, UoS students had a positive attitude, a moderate level of knowledge along with good level of self-confidence. Most of the respondents confirmed that PGx is relevant to their profession whereas, as it was indicated, a great percentage of students were aware of PGx clinical applications and its benefits. There is a slight difference between students’ attitudes based on their gender, while, they considered that lack of reimbursement, high PGx testing cost, shortage of trained personnel, and data privacy concerns were the main obstacles to slow PGx adoption. The majority of students were willing to broaden their knowledge in the field via a postgraduate course or a seminar. In addition, they intend to apply PGx testing in their clinical routine in the future and most of them would recommend a relevant test to a patient.

Based on the literature, undergraduate students who attend health-related courses in medicine, pharmacy, or nursing share a positive attitude toward PGx applications. In Wen and coworkers, 2022 study, it was shown that the vast majority of first-year pharmacy students in the United States considered PGx as a useful tool and 57% agreed that it is relevant to their profession while 22% totally agreed that PGx will be relevant to their clinical practice (Wen et al., 2022). Siamoglou and coworkers, 2021 also concluded with similar results. Students from Malaysia and Greece shared a positive attitude towards genetic testing and were aware of the benefits and relative advantages of preemptive testing (Siamoglou et al., 2021a). Finally, according to Shah and coworkers, 2022, female pharmacy students in Pakistan demonstrated a better attitude towards PGx testing compared to their male counterparts, an observation that comes in agreement with our results (Shah et al., 2022).

Most of the available publications indicated that undergraduate students showed a weak or moderate level of knowledge (Siamoglou et al., 2021b; Koufaki et al., 2022; Makrygianni et al., 2023). According to Makrygianni and coworkers, 2023, this factor did not exert any impact on students’ intentions (Makrygianni et al., 2023). Koufaki and coworkers, 2022 concluded that Malaysian and Greek pharmacy students had a rather low level of knowledge (Koufaki et al., 2022). Furthermore, Arafah and coworkers, 2022 mentioned that the overall level of knowledge of Saudi Arabian pharmacy students was low and that students lacked practical skills, an observation that was also made by Makrygianni and coworkers, 2023 (Arafah et al., 2022; Makrygianni et al., 2023). Makrygianni and coworkers, 2023, also presented that students were reluctant to answer advanced technical questions, and that had an impact on their self-confidence (Makrygianni et al., 2023). Finally, graduate pharmacy students expressed that gaining in-depth knowledge was a key to their future career advancement based on Koufaki and coworkers, 2023 (Koufaki et al., 2023).

Moreover, the level of knowledge was positively correlated with attitudes, an observation that agrees with the existing literature (Makrygianni et al., 2023). However, it was demonstrated that the moderate level of knowledge has not negatively affected students’ attitudes or self-confidence. Students have a high level of self-confidence about implementing PGx in the future and only items related to training readiness received less positive feedback, an observation that might be due to the level of knowledge. This is congruent with other studies (Mehtar et al., 2022 and Domnic et al., 2022). For instance, based on Mehtar and coworkers 2022, in Lebanon, approximately, 73% of all pharmacy students stated that they should be able to identify patients that might benefit from any type of genetic testing and they could use PGx, in their future practice (Mehtar et al., 2022). Regarding students’ reluctance in being able to adjust or alter a patient’s treatment following PGx testing, Domnic, and coworkers, 2022 study, pointed out that 36% of medical students agreed that they were confident to use the PGx results to stratify a patient’s treatment, whereas 40% agreed that they needed better knowledge (Domnic et al., 2022). This result comes per our findings.

Furthermore, barriers and concerns were indicated to be an influential factor and may determine students’ intentions to adopt PGx in their future clinical profession, especially those related to PGx testing cost, lack of reimbursement, and data privacy issues. Based on the literature, data privacy and results’ confidentiality are the most cited issues. Indeed, some studies pinpointed that the main concerns refer to data privacy and results’ confidentiality and others focused more on PGx logistics including costs, lack of trained personnel, and lack of complete clinical guidelines (Bank et al., 2018; Cheung et al., 2021). In the Netherlands, Bank and coworkers, 2018 showed that 72% of the participants expressed their concern about data use and the chance of being provided to unauthorized individuals while 88% believed that PGx testing results could provoke psychological distress to patients (Bank et al., 2018).

A study conducted by Cheung and coworkers, in 2021 had also come up with relevant results in Hong Kong (Cheung et al., 2021). Nonetheless, Koufaki and coworkers, 2022 stated that Greek students worried more about PGx cost and the lack of complete clinical guidelines while their Malaysian counterparts were concerned about data privacy (Koufaki et al., 2022). In the aforementioned study, it was implied that the difference between the two students’ cohorts was the cultural context because the local legislation and directives had affected students’ perceptions. In the present analysis, though, we did not notice extreme differences even if we investigated a highly diverse and multinational environment. The UAE is a cosmopolitan with diverse ethnicities from almost all over the world, working and studying together in an inclusive environment and respecting high standards of understanding and tolerance.

Finally, as far as respondents’ willingness to implement PGx in their professional lives, our findings come following the literature. Based on Arafah and coworkers, 2022 study, 61.2% of pharmacy students were interested in a PGx-related course or seminar (Arafah et al., 2022). The vast majority expressed an interest in participating in genetic research, and they were willing to undergo PGx testing, too (Arafah et al., 2022). Jarrar and coworkers, 2019, concluded with similar results; around 93% of pharmacy students were willing to learn more about PGx testing, whereas 31% opted to pursue a postgraduate program in the field (Jarrar et al., 2019). Finally, in a study that was conducted among professional pharmacists and pharmacy students in Lebanon, 62% of participants were interested in learning more about PGx while in Croatia, the majority of students (dental, medicine, pharmacy) were willing to undergo a PGx test, a finding that is close to our results (Bukic et al., 2022; Mehtar et al., 2022).

This study has a few limitations. The survey was conducted among undergraduate students of the University of Sharjah and it did not include any other UAE university. To overcome this limitation, surveys were distributed to four different colleges to broaden our research sample. Questionnaires were distributed online and not via direct contact. This fact might lead to response bias but it is not shown to have such case in our analysis. Furthermore, the response rate was estimated at 30%. This rate was low but the total sample is sufficient to get results with significant statistical power. Finally, students came from different academic background and this was not taken into consideration in the scope of this analysis to identify any differences.

PGx is a hot topic of personalized medicine with great clinical applications. Implementation of PGx in healthcare systems remains a major challenge. The adoption rate of PGx is quite low worldwide and also in the UAE. A key factor for expanding PGx application in the clinical practice is based on the involvement of healthcare professionals. The future generations of UAE healthcare professionals in this study were shown to be aware of PGx and had a good level of knowledge. Their attitude towards PGx was positive and a great percentage of them planned to incorporate PGx testing in the clinical routine, while they were more than willing to undergo a relevant test for themselves. Moreover, the respondents expressed their opinions and concerns about the most commonly shared barriers and challenges related to PGx testing. The cost of PGx testing, lack of specialized personnel, and data confidentiality were found to be the most important challenges for PGx clinical implementation. In future research, the impact of demographics including gender, academic background, and year of study on students’ intentions to adopt PGx in clinical practice will be investigated further.