Introduction: The field of genetics is rapidly expanding and people are increasingly utilizing genetic testing and counseling services. However, the current literature on genetic health topics and Filipinos remains limited, as many minority populations are not adequately studied. This study describes Filipino Americans’ attitudes and knowledge of genetic disease, genetic testing, and genetic counseling. To address these knowledge gaps and reduce the burden of health disparities, the informational needs of Filipino Americans regarding genetic disease and genetic services must be understood in order to better tailor these services and outreach methods. Methods: Fifteen semi-structured, qualitative interviews were held with individuals who self-identified as Filipino American between November 2022 and January 2023. Interviews were transcribed and coded using an iterative process. Results: Most participants were familiar with genetic disease and believed that factors such as biology, as well as cultural factors such as upbringing and food, contributed to its development. The majority of participants had previously heard of genetic testing; however, most participants either did not know much or were only familiar with ancestry direct-to-consumer genetic testing (DTC-GT). Most participants had not heard of genetic counseling and those that had heard of genetic counseling before did not understand its purpose. Overall, most participants had a positive attitude toward genetic testing and counseling. Participants identified the benefits of these services including genetic disease prevention, management, and treatment. Participants stressed the importance of educating the Filipino community and shared their ideas for how to implement outreach efforts. Discussion/Conclusion: This study found that Filipino Americans generally had a positive outlook on genetic testing and genetic counseling. We propose participant-generated ideas for outreach and education that may help inform future public health efforts that aim to educate this population about genetic disease, testing and counseling.

Filipino Americans are the third largest Asian subgroup in America after Chinese and Indian Americans and make up 19% of the Asian population [1, 2]. Despite its large size, the Filipino American community’s awareness of and experiences with genetic services have been overlooked in the genetic health services literature. Filipino Americans are often categorized under the umbrella term “Asian” and the unique identities and experiences among Filipinos, as well as other Asian subpopulations, are erased [3].

Genetics is a growing field in healthcare and more people are utilizing genetic services such as genetic testing and genetic counseling in order to better understand genetic disease [4]. As the abundance of genetics research continues to grow, new treatments, prevention, and diagnosis methods have been discovered, illustrating its practical utility in healthcare [4]. Despite its proven utility, awareness of genetic disease and utilization of services remains unequal across different racial and ethnic groups [5]. Recent studies have found consistent inequities among Asian Americans as it relates to awareness of and access to genetic services [6, 7]. Many of the studies that document Asian American genetic health inequities rarely describe Filipino populations. A systematic review on genetic counseling and testing for Asian Americans found only two studies out of 47 that described Filipino Americans. Additionally, the findings were not stratified based on Asian subgroups, which further masks Filipino experiences [8].

Filipino Americans differ from other Asian American subgroups due to the unique immigration history from the Philippines to the USA [9]. The USA has a deep-rooted history of importing Filipino nurses as early as 1898 when the Philippines was colonized by the USA. Later, World War II created another demand for nurses from the Philippines to work in the USA [10]. Today, nearly one-third of foreign-born nurses in the USA are Filipino [11]. This history has had long-lasting effects on Filipino culture, attitudes, beliefs, and self-identity. The Philippines is the only Asian country with a predominantly Catholic religion, with 85% of the population identifying as Catholic [12, 13]. This unique immigration history shapes Filipino Americans’ values and views on disease causation and services within the American healthcare system. Each of these factors contributes to the unique Filipino identity and serves as evidence to study this group independently from other Asian groups.

Filipino Americans also face unique health concerns. Conditions such as diabetes, hypertension, obesity, hyperuricemia, and gout are more common in Filipino Americans compared to other Asian subgroups [3, 14‒18]. It is important to note that many of these conditions are considered multifactorial and caused by a combination of genetics and environmental factors [19]. These prevalent diseases among Filipinos and culture-specific disease beliefs further support the need for genetic health professionals to facilitate conversations pertaining to genetic disease and to help support and inform this population in a culturally sensitive manner [6, 20].

Filipino Americans face significant adversity when dealing with health issues and healthcare systems. Specifically, cultural and language barriers, financial challenges, and limited social support were described to be associated with potentially preventable hospitalizations [20]. One study noted that healthcare providers (HCPs) delivered inequitable care by assuming English proficiency among Filipino patients [21]. While English proficiency is common in the Philippines, it should not be assumed that it is the preferred language to communicate health information. The negative experiences of Filipino Americans within the American health system stress the need for HCPs, including genetic counselors, to be more aware of the unique experiences, culture, and general awareness of health topics such as genetics among Filipino Americans.

Currently, there is a dearth of studies that have explored Filipino Americans’ general understanding and views on genetic health topics. This study directly addresses these gaps with the broader goal of providing suggestions for culturally sensitive genetic counseling and targeted outreach methods that take into account Filipino American preferences. The aims of this study were to explore Filipino Americans’ beliefs about heritability and genetic disease, and Filipino Americans’ attitudes and knowledge of genetic disease, genetic counseling, and genetic testing.

Due to the exploratory nature of this study, a semi-structured interview format was established to allow for flexibility in responses while also obtaining rich qualitative data from participants. This study was reviewed and approved by the Northwestern University Institutional Review Board (IRB).

The research team constructed a semi-structured interview guide based on the research aims and demographic information. A brief education regarding genetic disease, counseling, and testing was also provided to each participant during the interview. This education consisted of a brief and scripted verbal description of each concept. This was provided to each participant once the relevant questioning for that topic was concluded. The same author conducted all of the interviews and performed the brief education. The guide was minimally altered after the initial two pilot interviews, and deployed among an additional 13 participants. The interview guide queried participants’ demographic information, and their awareness and attitudes toward genetic disease, genetic counseling, and testing.

Recruitment and Sampling

Participants met the following inclusion criteria: 18 years or older, fluent in English, and self-identified as Filipino. We employed various strategies to recruit participants, including in-person distribution of fliers and reaching out to Filipino community organizations. Seven organizations were approached, and two agreed to disseminate the flier. Participants were recruited through in-person flier distribution, Leadership Education Activism and Open Dialogue (LEAD) Filipino, a California-based Filipino organization, and the Asian American Research Center on Health (ARCH). Fliers were distributed in three cities: Chicago, IL, USA; Daly City, CA, USA; and Seattle, WA, USA, all of which have large Filipino American populations. Specific sites, such as Chinatown in Chicago, and a Filipino goods shopping mall, were chosen for flier distribution based on high levels of foot traffic and an increased chance of encountering Filipino individuals. Prospective participants were approached, provided with an overview of the study, and instructed to send an email if they desired to participate. Eligibility criteria were confirmed, and consent information was sent to participants via email. The first 15 participants who responded and met study criteria were enrolled in the study. A total of 15 individuals were interviewed. The study team met weekly to discuss data collection and findings arising from the interviews. When data saturation was reached, recruitment efforts were concluded.

Interview Procedure

Phone interviews were held and audio recorded between November 2022 and January 2023. Consent information was reviewed during the phone interview and verbal consent was obtained for each participant. The interviews lasted approximately 30–60 min and were conducted in English. Audio recordings of the interviews were transcribed and de-identified by the lead author. Participants received a $35 VISA gift card for their participation.

Data Analysis

The qualitative approach used in this study was a blend of constructivist grounded theory and interpretive description for data analysis [22, 23]. The coding team was comprised of three researchers trained in qualitative methods; one had extensive qualitative research experience and led the coding team. Initially, three coders separately conducted open coding on five transcripts, selected for greatest variability, to identify significant content and memo about potential codes. The team then met and collaboratively developed a preliminary list of codes and the first author then drafted a codebook. After this, the team used the agreed-upon preliminary list of codes to conduct focused coding on a second set of two transcripts to refine, expand, and define extant codes, define parameters for their utilization, and cluster codes into thematic groups. This iterative process was repeated a third time with two additional transcripts to further refine the codes and appropriate application to transcripts. Then, the lead author entered these codes and their emergent definitions and parameters for utilization into Dedoose v.9.0.86 software. Two researchers then independently coded five transcripts to test and refine the codebook and to check inter-coder reliability. All three coders discussed any coding discrepancies while working towards agreement. Once a consensus was reached on utilization of codes and definitions, two researchers completed an inter-rater reliability test on Dedoose and obtained a score >80% [24]. The lead author then independently coded the remaining six transcripts.

Participant demographics are presented in Table 1. All participants (n = 15) self-identified as Filipino. Thirteen participants were born in the USA and grew up in a variety of regions including nine from the West Coast, two from the Midwest, two from the Middle Atlantic, and one from the Southwest. Two participants were born outside of the USA. Most participants were between 18 and 25 years old (n = 12). None of the participants had children. Most participants were students in college (n = 8) or recently completed their Bachelor’s degree (n = 4). Many students were unemployed (n = 6); however, two worked as researchers.

Table 1.

Participant demographics

Participants, n
Age range 
 18–23 
 24–29 
 30–35 
 Average age, years 23 
Gender identity 
 Female 10 
 Male 
Highest level of education completed 
 High school 
 Some college 
 Bachelors 
 Masters 
Ethnicity 
 Filipino/a 13 
 Half Filipino/a 
Language(s) 
 Some Tagalog 
 Fluent Tagalog 
Birth country 
 USA 13 
 Germany 
 Philippines 
Parents birth country 
 Philippines 24 
 USA 
 Guam 
 Korea 
 Middle East 
Religion 
 Catholic 
 Not religious 
Individual income 
 $0–24,999 
 $25,000–49,999 
 $50,000–74,999 
 $75,000+ 
Participants, n
Age range 
 18–23 
 24–29 
 30–35 
 Average age, years 23 
Gender identity 
 Female 10 
 Male 
Highest level of education completed 
 High school 
 Some college 
 Bachelors 
 Masters 
Ethnicity 
 Filipino/a 13 
 Half Filipino/a 
Language(s) 
 Some Tagalog 
 Fluent Tagalog 
Birth country 
 USA 13 
 Germany 
 Philippines 
Parents birth country 
 Philippines 24 
 USA 
 Guam 
 Korea 
 Middle East 
Religion 
 Catholic 
 Not religious 
Individual income 
 $0–24,999 
 $25,000–49,999 
 $50,000–74,999 
 $75,000+ 

The findings of this study are organized into three main themes reported by Filipino American young adults. The first theme focuses on genetic disease beliefs and the most commonly discussed diseases that participants perceived to have a genetic component. The second theme depicts both positive and negative attitudes toward genetic counseling and testing including the discussion of direct-to-consumer genetic testing (DTC-GT). The third theme illustrates participants’ desire to learn more about genetic disease, counseling, and testing and emphasize on the importance of education and ideas for outreach.

Theme 1: Genetic Disease Is Caused by Biological, Environmental, and Behavioral Factors

Participants were asked to share their thoughts on genetic diseases that can be “passed down.” The most commonly discussed diseases were diabetes, cancer, hypertension, and heart conditions. Other conditions included mental illness and gout. The majority of participants (n = 14) described that they believe such diseases are caused by genetics or biology. However, over half of the participants (n = 8) also described environmental factors such as upbringing, food, and culture, and generational trauma/curses as possible causes of genetic disease. Most participants described learning about genetic disease in high school (n = 6), whereas others learned about it in middle school (n = 2), college (n = 2), from their family (n = 4) or from doctors (n = 1). All participants (n = 15) described knowledge of their family health history and health communication amongst family members. All presented quotes for this theme were prompted by the question, “What comes to mind when I say the phrase ‘genetic disease’?”

Participants described their beliefs that genetic diseases can be passed on from one generation to the next and how this is a continuous cycle that may persist throughout a family. One participant specifically mentioned how these biological and genetic aspects are uncontrollable factors.

I think it's…mostly the fact that you were just born [with it]. It’s not really something you can control but it’s something that was passed down to you, because you inherit the things that make you up and things that you can't control. (Participant 3 [23-year-old female])

Participants also described environmental factors contributing to genetic disease such as the external surroundings and climate, while behaviors are defined by actions such as food consumption. Another theme that emerged was the participants’ beliefs that their upbringing or their family’s ability to access resources was related to genetic disease. One participant mentioned that their parents did not have money or access to healthy foods growing up in the Philippines.

My parents grew up in poverty in the Philippines, and so I kind of associated that with also economically, you know, are we susceptible to these diseases because at the end of the day can we afford or have access to better food to cook for us…So I think, like the way the access to like food has a lot to do with the genetic diseases that I'm thinking of right now. (Participant 14 [25-year-old female])

The relationship between food and genetic disease was a common topic among participants. Many of them (n = 8) described Filipino cultural foods as not having many vegetables, and instead, having a lot of pork, white rice, and fried food. This was viewed as being suboptimal for their health and disease-causing.

Filipino food has a lot of sodium. That’s just normally what's in a lot of Filipino food and that is a big cause of high blood pressure. (Participant 13 [25-year-old female])

Other environmental factors related to genetic disease that participants mentioned included the unique climate in the Philippines, generational trauma, and lack of health education. Unprompted beliefs about generational trauma were described by two participants. This included discussion of how the experiences from an older generation, shape, and affect the lives of those living in younger generations within the same family.

My mom grew up with this mindset of, if I want a better life I have to work… So my parents were kinda absent in my upbringing, and I unfortunately was bullied in school…, and I unfortunately developed depression. (Participant 11 [23-year-old female])

Two participants described the notion of God’s will, as it relates to genetic disease. This was described as a willingness to accept the outcome of life circumstances. However, it was noted that while older generations may be more likely to have these religious views on life and genetic disease, this does not preclude them from believing in the healthcare system or scientific explanations for genetic disease.

I think that we also do have a pretty strong belief in healthcare systems… I would say that there’s more of this “God's will” or “God's plan” more willingness to accept the outcome or even just thinking what will be will be. (Participant 3 [21-year-old male])

Theme 2: Participants’ Awareness of and Attitudes toward Genetic Counseling and Testing

Participants’ levels of awareness of genetic disease, testing, and counseling varied across topics (see Table 2). Only one participant had not heard of genetic disease prior to the interview. Those who had heard of genetic disease described not knowing much about it aside from a basic understanding of the inheritance. Most participants had heard of genetic testing but only had a limited understanding. Many participants’ only knowledge of genetic testing was DTC-GT, usually in the form of ancestry testing. One participant had done DTC-GT previously for both ancestry and health conditions. Most participants had not heard of genetic counseling and the two participants who had heard of it before did not really know what it meant.

Table 2.

Participant awareness of genetic disease, testing, and counseling

Participants, %Quote
Had heard of genetic disease? 93 I don't really have much information or knowledge within genetic disease. Just that there are certain diseases that can be passed down genetically from family member to family member. (Participant 14 [25-year-old female]) 
When I hear genetic disease, the word “disease” feels a little intimidating because I don't come from a healthcare and medical background… and maybe if I knew more… I would feel less worried. (Participant 2 [23-year-old female]) 
Had heard of genetic testing? 73 I have heard of it but I don't know a lot about it. (Participant 11[23-year-old female]) 
I’ve definitely heard of the term genetic testing, just… I haven't had any experience discussing it with family or anybody really. (Participant 5 [19-year-old female]) 
Had heard of genetic counseling? 13 Oh, I would definitely say it's the first time I've heard of genetic counseling. I mean, it does make sense in terms of healthcare. I feel like a lot of healthcare does have counseling first before the next step of the process. But it's not something I ever thought about. (Participant 6 [26-year-old male]) 
I've heard the term passed around, but I've never really heard what it meant before, or I didn't really know what It was. (Participant 3 [21-year-old male]) 
Participants, %Quote
Had heard of genetic disease? 93 I don't really have much information or knowledge within genetic disease. Just that there are certain diseases that can be passed down genetically from family member to family member. (Participant 14 [25-year-old female]) 
When I hear genetic disease, the word “disease” feels a little intimidating because I don't come from a healthcare and medical background… and maybe if I knew more… I would feel less worried. (Participant 2 [23-year-old female]) 
Had heard of genetic testing? 73 I have heard of it but I don't know a lot about it. (Participant 11[23-year-old female]) 
I’ve definitely heard of the term genetic testing, just… I haven't had any experience discussing it with family or anybody really. (Participant 5 [19-year-old female]) 
Had heard of genetic counseling? 13 Oh, I would definitely say it's the first time I've heard of genetic counseling. I mean, it does make sense in terms of healthcare. I feel like a lot of healthcare does have counseling first before the next step of the process. But it's not something I ever thought about. (Participant 6 [26-year-old male]) 
I've heard the term passed around, but I've never really heard what it meant before, or I didn't really know what It was. (Participant 3 [21-year-old male]) 

The majority of participants (n = 13) had a positive attitude toward genetic testing and counseling, and all 15 participants believed genetic counseling was beneficial. Similarly, most participants expressed a personal interest in genetic counseling and testing. Some (n = 3) participants mentioned that they wanted to find a genetic counselor near them to discuss if they could get genetic testing or if it would be indicated based on their family histories. Those who held negative attitudes mainly discussed mistrust of direct-to-consumer testing due to privacy issues and lack of awareness of how a person’s genetic information is used. Participants who had knowledge regarding the differences between medical provider-ordered genetic testing versus DTC-GT stated that they trusted medical providers over private DTC companies.

I think genetic testing is a good thing because when you're aware of what diseases you may have or more susceptible for, what kind of genes you have, then that allows you to make better informed decisions on how you want to live your life. (Participant 14 [25-year-old female])

The same participant expressed their positive views on genetic testing but had negative views on direct-to-consumer testing and fears relating to misuse of their genetic information and lack of transparency.

I think the worry for me is I don’t want to give my DNA to a private company… I haven’t done the research to know whether or not they're going to use my genetic makeup for their own benefit or a use that I don't necessarily consent to. (Participant 14 [25-year-old female])

Some (n = 2) also described having negative views on genetic testing due to worry and fear that their parents and grandparents have instilled in them.

Multiple people in my mom’s generation have told me that they don't want to be cloned by the government so they’re not going to give their DNA to people… So it’s been kind of ingrained to me not to necessarily trust genetic testing. (Participant 9 [18-year-old female])

Despite some negative attitudes toward genetic testing, all participants described positive views on genetic counseling due to the support that it provides patients during difficult moments in their life.

I could just imagine the emotional and physical toll [genetic disease] might have on people and their families. So having a genetic counselor would really help put their mind at ease, and kind of help them navigate through the process of dealing with the disease. (Participant 8 [27-year-old female])

One of the most prevalent themes that emerged was the value of genetic testing in the context of health promotion and prevention. Participants had positive attitudes toward genetic testing, as a means for health prevention. This was viewed as a positive aspect of genetic testing which can be used to help empower patients to better take care of their health. Participants believed that by understanding their own genetic risks, they could better prevent negative health outcomes. It was also noted that genetic testing may help reduce future healthcare costs via early diagnosis.

You know the earlier you take these tests and if you do have an underlying disease. You can treat that disease much earlier before it gets or before it’s too late. So I feel like you can definitely prevent a lot of unnecessary costs and treatments by addressing it early on. (Participant 8 [27-year-old female])

Other participants (n = 5) mentioned the utility of genetic testing as it pertains to helping accurately diagnose people with genetic disease and treating them accordingly based on the test results. Most participants (n = 11) expressed an interest in learning more about genetic counseling and testing services for themselves or their family members. Participants commonly discussed genetic counseling and testing as useful to provide people with more information for themselves and their families about their risk for genetic disease.

I think that it interests me a lot, because I feel like it gives people the opportunity to identify where genetic diseases come from, their family history, and what they might be at higher risk for. It could affect how someone chooses to live their lifestyle, so it seems really interesting and informative. (Participant 2 [23-year-old female])

While the majority of participants expressed interest in genetic counseling and testing, some (n = 2) described that they would not be interested due to their desire to “live in the moment” and a lack of desire to know future health-related information.

Personally, I really like to just try and live in a moment and whatever happens is really just meant to happen. So I think personally, I wouldn't do it. I would just, you know, just try to live a healthier lifestyle on my own terms. (Participant 15 [25-year-old female])

This quoted ideology was described by two participants who both identified as Catholic, as well as by participants who believed older generations would not be interested due to their Catholic beliefs such as “God’s will.” Some participants (n = 3) also expressed that they believe older generations of Filipinos would not be interested in genetic testing due to their lack of familiarity and understanding of what it is. Some participants also described that older generations may not be as open to the idea of genetic counseling due to stigma surrounding the word “counseling” as there is often a lack of recognition of mental health.

Theme 3: Participants’ Suggestions for Education and Outreach in the Filipino Community

Many participants expressed that they wanted to learn more about genetic-related services and that they felt it was important to educate the Filipino community on genetic disease, testing, and counseling. A summary of participants’ ideas for outreach and education on these topics is depicted in Table 3.

Table 3.

Participant ideas for education and outreach in the Filipino community

MethodQuote
Social media One thing that I know for sure is social media… it can also be used for the better…with genetics as well, I feel like that’s something that can be definitely talked about on social media. (Participant 11 [23-year-old female]) 
Word of mouth I think always I think word of mouth is just as big as anything, especially with Filipinos… Like, if you get a good group to start doing it… if you got someone like my aunt, she is a part of… the Filipino group here if you got her to do it because she knows a lot of people, and then if she were to tell people those people, they would follow her. (Participant 13 [25-year-old female]) 
Events and presentations Tabling at events could be really helpful. There’s actually a Filipino community here… and you can actually table there and present whatever it is you want… And also giving free online presentations about it, I think is also a good way to go about it as well. (Participant 8 [27-year-old female]) 
Community centers I think here, a big way that the Filipino community distributes information is through the community center… So, I think it does start at a community level, and being able to rely on and also disseminate information around people you trust. (Participant 9 [18-year-old female]) 
MethodQuote
Social media One thing that I know for sure is social media… it can also be used for the better…with genetics as well, I feel like that’s something that can be definitely talked about on social media. (Participant 11 [23-year-old female]) 
Word of mouth I think always I think word of mouth is just as big as anything, especially with Filipinos… Like, if you get a good group to start doing it… if you got someone like my aunt, she is a part of… the Filipino group here if you got her to do it because she knows a lot of people, and then if she were to tell people those people, they would follow her. (Participant 13 [25-year-old female]) 
Events and presentations Tabling at events could be really helpful. There’s actually a Filipino community here… and you can actually table there and present whatever it is you want… And also giving free online presentations about it, I think is also a good way to go about it as well. (Participant 8 [27-year-old female]) 
Community centers I think here, a big way that the Filipino community distributes information is through the community center… So, I think it does start at a community level, and being able to rely on and also disseminate information around people you trust. (Participant 9 [18-year-old female]) 

Participants were interested in these services but did not feel like they knew enough about the topics, most often genetic counseling. One participant specifically described their desire to know more about genetic counseling and shared thoughts on spreading awareness about it in the Filipino community.

I’ve never talked about genetic testing specifically, or genetic counseling… I feel like that’s something that I would love to bring up and even do more research on because it’s something that does sound very interesting, especially when it comes to the overall well-being of you and your family as well. (Participant 11 [23-year-old female])

Some participants (n = 3) expressed how throughout the process of the interview they became more curious about their genetic health. At the end of the interview process, two participants asked if they were able to ask questions about genetic disease, testing, or counseling as well as where to go for further information and resources.

One participant described the need for people to be more educated about genetic counseling as a healthcare service. She describes the privilege for those who have family members working in healthcare as it provides familiarity and access to healthcare services.

And I think people need to be more…aware that that’s an option, because I feel like in some backgrounds people aren’t as educated on how important it is to be aware of your health and your genetic components… a lot of my family are nurses, so it’s always just been like something that kind of felt more familiar to me. But I’m sure that there are families out there that aren't as aware of it, and it could actually affect their choices and their lifestyle. (Participant 2 [23-year-old female])

Participants were asked to share their ideas on how to best reach out to the Filipino community regarding education on genetic disease, testing, and counseling (Table 3). As shown in Table 3, there were multiple ideas about ways to educate the Filipino American community. Many participants discussed personal anecdotes in which they provided a basis as to why their suggested method would be useful to them or someone in the Filipino community. There was a mix of suggestions including utilization of online and in-person methods. One participant described targeting Catholic churches due to the tie between Catholicism and Filipino culture. While many methods of outreach were mentioned, there was no single most popular method that participants identified.

This qualitative study highlights the unique cultural identities and lived experiences of Filipino Americans that shape the way they understand and view genetic disease, genetic counseling, and genetic testing. Participants were mostly young adults, second generation immigrants; and while they may be less familiar with the Filipino names for certain traditional beliefs, many of their statements about disease causation mirror these traditional concepts. Although none of the participants explicitly mentioned specific concepts by their Filipino name, “namamana” or the notion of inheritance, and “bahala na” which captures the idea of leaving it to God, align closely with the participants’ descriptions of genetic causes of disease [25, 26]. Participants’ belief in “God’s will” exemplified their willingness to accept the outcome of life circumstances and stems from Filipino Americans’ intertwined identity of Catholicism and Filipino culture. The belief in “God’s will” is consistent with previous research that found this belief helped Filipino American breast cancer survivors cope with adverse life circumstances [27]. This may have implications for Filipinos who are religious, regarding their perceptions of control and utility or outcomes of genetic testing.

Participants frequently mentioned the belief that food or Filipino diet was a potential cause of genetic or hereditary diseases. Food insecurity and poverty in the Philippines were described as a factor to prevent access to healthy food options. This finding may also translate to a US context, where Filipino Americans experience a significantly higher prevalence of food insecurity compared to Asian Americans as a whole [28]. This emerging theme serves as further evidence to disaggregate data for Asian American subgroups, such as Filipinos.

The value of health communication among Filipino families has been documented previously [29] and many of our study participants mentioned the importance of promoting and participating in health communication in the Filipino culture. Other studies have cited that Asian Americans in general are unfamiliar with their family health histories and unable to share information with their healthcare providers, thus missing crucial opportunities to identify hereditary illness [8]. Our study stands in contrast to these findings and serves as further evidence for the need to independently study subgroups within Asian populations in order to discover nuances that are not captured when categorizing Asian individuals under one umbrella category. These findings may also help inform healthcare practices and public health education that emphasize familial values, allowing for targeted outreach methods among the Filipino community.

Our participants’ generally positive attitudes toward genetic counseling and testing mirror previous studies on racial and ethnic minority populations [5, 29, 30]. The younger generation of participants in this study may be more informed about the ethical issues associated with DTC-GT which may explain some of the negative views on this form of genetic testing. However, participants expressed more trust in medical provider-ordered genetic testing, which may be related to the fact that many of them had family members who work in the healthcare field, the majority of whom were nurses. Because of these close familial relationships in the healthcare field, there may be increased levels of trust in the medical community, in addition to higher levels of awareness and understanding of genetics in this sample population compared to the general public.

This study reflects useful themes relating to young adult Filipino Americans’ knowledge of genetic disease and attitudes toward genetic health services. This information provides a foundation for healthcare providers, such as genetic counselors, public health educators, and outreach coordinators to consider when interacting with the Filipino population. Participants also provided suggestions for modes of outreach and educational needs that may help guide future efforts that aim to engage with this population in an effective way.

Strengths of this research study include the utilization of diverse recruitment methods such as community-based recruitment. However, there may be possible recruitment bias due to the recruiter being of the same age range as the sample population, as well as locations of recruitment. The recruitment methods resulted in a homogenized age sample of young adult Filipino Americans, mostly under the age of 30. In 2019, it was reported that only 17% of Filipino Americans ages 18–29 years old, and therefore our study sample was not representative of the age distribution of Filipino Americans [31]. Most of the study sample had some college education (n = 8; 53%), while it has been documented that only 30% of the general Filipino population was reported to have some college education [32]. Compared to the general population, participants may have been more knowledgeable on genetics-related topics because of their exposure to college education. Thus, the findings of this study cannot be generalized to other Asian subgroups, older Filipino Americans, or Filipino Americans with children. Based on limitations described, it would be useful to have a larger and more representative sample of the Filipino American population in order to determine how generalizable our results are. Diversity across age groups, immigration experiences, or linguistic factors would help further our understanding of Filipino Americans’ attitudes, knowledge, and informational needs regarding genetic disease, testing, and counseling.

In order to have a better understanding of Asian subgroups, such as Filipinos, and to prevent harmful generalizations, it is crucial to conduct studies across these communities independently. This study recognizes the unique nuances and experiences of young adult Filipino Americans within this larger ethnic group. Our findings from this study illuminate important knowledge gaps related to possible health disparities in genetic services education and access and provide concrete recommendations for reaching this population in a culturally sensitive manner.

Thank you to LEAD Filipino and ARCH for assisting in recruitment of participants. Thank you to Northwestern University Graduate Program in Genetic Counseling for funding this study.

Study protocols and human subjects’ considerations were reviewed and approved by the Institutional Review Board (IRB) at Northwestern University, approval number STU00215729. All participants were provided consent information and the interviewer reviewed this information prior to each interview. All participants had the opportunity to ask questions and provided voluntary verbal consent to participate in this research. The verbal consent process was approved by the IRB at Northwestern University.

Debra Duquette is a paid consultant for the Centers for Disease Control and Prevention, Division of Cancer Prevention and Control; the Genetic Testing Advisory Board for AIM Specialty Health; and Natera’s Hereditary Cancer Advisory Board. Casey R. Scherer, Priscila D. Hodges, Maricar Macalincag, Jennifer Shin, and Jennifer L. Young declare that they have no conflicts of interest.

Funding was provided by the Northwestern University Graduate Program in Genetic Counseling.

C.R.S., D.D., P.D.H., M.M., J.S., and J.L.Y. made substantial contributions to the conception of the work. C.R.S. was responsible for writing the manuscript and revisions. D.D., P.D.H., M.M., and J.L.Y. were responsible for the critical review. C.R.S., J.S., and J.L.Y. contributed to the data analysis. All authors gave final approval for this version to be published and agreed to be accountable for all aspects of the paper.

Additional Information

*The ethnic identity “Filipino” will be used throughout this study as this is how participants chose to self identify. The authors of this study respect and understand the various ways in which Filipina/x/o Americans may prefer to identify.

The data that support the findings of this study are not publicly available due to their containing information that could compromise the privacy of research participants but are available from the corresponding author [C.R.S.] upon reasonable request.

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