Public responses to risk communication during the 2025 Chikungunya outbreak in China: Implications for future epidemic preparedness.

Abstract

To examine associations between exposure to risk communication, risk perception, and critical health literacy, and their associations with public preparedness and preventive behaviors during the Chikungunya epidemic in China. We conducted a cross-sectional survey in August 2025 among 1102 residents across three Chinese provinces, stratified by epidemiological risk. Among participants aware of the outbreak (n = 761), multivariable logistic regression models assessed associations between risk communication, risk perception, critical health literacy, and preventive behaviors, adjusting for sociodemographic characteristics. Among participants, 69.06% reported awareness of Chikungunya. Higher exposure to risk communication was associated with increased adoption of all preparedness and preventive behaviors (aORs 1.31-1.50). Perceived environmental risk was associated with using mosquito nets [aOR = 1.37, 95% CI (1.14, 1.64)], screening windows [aOR = 1.45, 95%CI (1.18, 1.78)], and purchasing medications, including paracetamol, antibiotics, and antivirals (aORs up to 1.73). Higher critical health literacy was associated with reduced likelihood of purchasing inappropriate medications, specifically antibiotics [aOR = 0.72, 95% CI (0.56, 0.92)] and antivirals [aOR = 0.58, 95% CI (0.45, 0.75)]. Governmental risk communication and critical health literacy were strongly associated with public preventive behaviors. Findings suggest interventions to improve critical health literacy and risk communication could enhance preparedness and safer practices in future epidemics.