Comments on “Changes in Italian Nurses' Genetic Knowledge and Perceptions Over a Decade”

We read with great interest the study by Godino and colleagues, titled “Changes in Italian Nurses' Genetic Knowledge and Perceptions Over a Decade” (Godino et al. 2026). This work offers a rare and valuable longitudinal perspective on an important and underexplored question in European nursing education research: has a decade of genomic advancement translated into measurable gains in how nurses understand, perceive, and apply genetics in clinical practice? The answer emerging from this study is both encouraging and sobering. Knowledge scores improved meaningfully—with 78.9% of nurses correctly answering at least four of five knowledge questions compared to 60.5% in 2011—yet perceived relevance and clinical confidence have remained virtually unchanged over the same period (Godino et al. 2026). This striking dissociation between theoretical knowledge and practical integration is the central and most important contribution of this study, and it deserves both recognition and deeper theoretical engagement. We wish to build on this contribution by offering several constructive reflections and concrete directions for future research and educational policy. The near-static rates of perceived relevance (26.9% vs. 26.8% in 2011) and high clinical confidence (8.3% vs. 7.3%) despite an 18-percentage-point improvement in knowledge scores invite a fundamental theoretical question: why does increased knowledge not translate into greater confidence or perceived applicability? The study rightfully points to insufficient practice-oriented training as a proximate explanation, as richly illustrated by the qualitative data. However, we suggest that Bandura's self-efficacy theory offers an important additional lens (Bandura 1997). Self-efficacy—the belief in one's capacity to execute specific behaviors in specific contexts—is not predicted by knowledge alone but is shaped primarily by mastery experiences, vicarious learning, social persuasion, and physiological states. In the absence of structured clinical opportunities to apply genomic knowledge, even high factual scores are unlikely to generate the contextualized confidence needed for practice integration. Future studies would benefit from formally assessing self-efficacy alongside knowledge, using validated instruments such as the Genomics Nursing Concept Inventory or the Genomic Self-Efficacy Scale (Hickey et al. 2018; Genomic Nursing State of the Science Advisory Panel et al. 2013), to clarify the psychological mechanisms underlying this persistent gap. The study's five-item knowledge instrument, retained for comparability with the 2011 survey, captures only elementary Mendelian concepts—a limitation the authors acknowledge. Contemporary competency frameworks, including those updated by Calzone et al. (2024) and those proposed through Delphi consensus by Tognetto et al. (2019), now emphasize clinical decision-making informed by genetic findings, pharmacogenomics, multi-gene panel interpretation, and effective communication of probabilistic risk to patients and families. We recommend that future iterations of this survey incorporate vignette-based or scenario-embedded items that assess applied reasoning in clinically realistic contexts (Lim et al. 2025; Parviainen et al. 2023), as these approaches have demonstrated greater sensitivity in detecting competency deficits that simple factual recall cannot capture. Importantly, retaining a subset of the original five questions would preserve longitudinal comparability while extending the assessment's construct validity—a methodological strategy that serves both continuity and rigor. The qualitative data powerfully illustrate that nurses working in areas where genomics is clinically central—including oncology, neonatal intensive care, and cardiology—still struggle to apply their knowledge in practice. This suggests that educational interventions alone are unlikely to be sufficient if structural and professional-role barriers remain unaddressed. Italy, like many European countries, currently lacks formal recognition of the genetic nurse specialist role (Paneque et al. 2016; Abacan et al. 2019), which limits both professional identity and the visibility of genomics as a legitimate nursing domain. We propose that future research explicitly examine how role clarity, institutional support, and ward-level culture moderate the knowledge-to-practice transition. Implementation science frameworks, such as the Consolidated Framework for Implementation Research (CFIR) or the Theoretical Domains Framework (TDF), offer practical tools for mapping these multi-level barriers and for designing interventions that operate simultaneously at the individual, team, and organizational levels (Nilsen 2020). The growing interest in genetics education among survey respondents—with 86.7% expressing a desire for further training, up from 86.2% in 2011—represents a meaningful motivational foundation upon which educational reform can build. Recent evidence suggests that accessible, technology-enhanced continuing education can produce measurable gains in genomic knowledge and awareness, as demonstrated by WhatsApp-based training among nurses in Turkey (Ceylan et al. 2025). Mobile and digitally delivered learning holds particular promise for overcoming geographic and institutional barriers to continuing education in countries with diverse healthcare landscapes such as Italy. However, we would caution against a purely top-down approach to curriculum design. A co-design methodology—in which practicing nurses, nurse educators, genetic specialists, and patient representatives collaboratively develop training content and delivery modalities—is more likely to produce interventions that are contextually relevant, perceived as legitimate, and ultimately embedded in practice rather than treated as an external imposition (Greenhalgh et al. 2016). Future studies incorporating participatory design and process evaluation components would substantially advance the evidence base for genomic nursing education in Italy and across Europe. The study by Godino et al. makes an important and timely contribution by documenting the persistence of the knowledge–practice gap in Italian nursing genomics over a decade. Moving forward, we suggest that progress in this field requires a shift from descriptive surveillance of knowledge deficits toward theoretically grounded, multi-level, and co-designed interventions that address not only what nurses know, but how they come to feel capable and supported to apply that knowledge in the complex realities of clinical practice. We thank the authors for providing this valuable reference point and look forward to the next chapter of this important longitudinal endeavor. Ayman M. Mustafa: conceptualization, investigation, writing – original draft, writing – review and editing. Bashir M. Rasul: conceptualization, investigation, writing – original draft, writing – review and editing. The authors have nothing to report. The authors have nothing to report. The authors declare no conflicts of interest.