Health communication gaps and stated willingness to receive hepatitis E vaccination and testing among outpatients with chronic liver disease in southwestern China: a cross-sectional study

Patients with chronic liver disease (CLD) are vulnerable to severe outcomes after hepatitis E virus (HEV) infection, yet HEV-related risk communication and acceptance of preventive measures among CLD outpatients in southwestern China remain poorly described. We assessed HEV-related knowledge, attitudes, and practices (KAP), prevention intentions, and associated factors. We conducted an anonymous, QR-code-based cross-sectional survey of adult CLD outpatients at West China Hospital between October and December 2025. The 37-item questionnaire assessed HEV knowledge, attitudes, practices, and prevention preferences. Knowledge was scored on a 23-point scale; scores of 14 or higher were reported descriptively. Multivariable logistic regression examined factors associated with definite willingness to receive paid vaccination, vaccination under a hypothetical free scenario, or HEV testing, with unsure and unwilling responses combined as the reference category. Among 504 respondents, 17.5% had heard of hepatitis E, 19.8% knew that an HEV vaccine exists, 17.3% recognized the increased risk of severe HEV in CLD, and 19.0% met the prespecified 60% descriptive threshold. Blood products (68.1%) and sexual contact (59.5%) were endorsed more often than food (25.4%) or water (15.3%) as perceived HEV transmission routes; 13.9% identified both food and water. Reported willingness was 56.2% for paid vaccination, 67.9% under a hypothetical free-vaccination scenario, and 60.3% for HEV testing. In adjusted models, knowledge scores of 9 or higher were associated with HEV testing willingness (aOR 1.78). Liver-disease health education was associated with vaccination willingness under paid and hypothetical free scenarios (aORs 2.26 and 2.86); aORs for self-reported immunosuppressive therapy were 1.56 and 1.64. Associations of health education and immunosuppression with vaccination willingness were less consistent across sensitivity analyses than the knowledge-testing association. Among CLD outpatients at a tertiary hospital in southwestern China, HEV knowledge, especially of food- and waterborne transmission, was limited despite substantial stated willingness to receive vaccination and testing. Knowledge and attendance at liver-disease health education were associated with testing and vaccination intentions, respectively. Prospective studies should assess whether targeted communication and improved access translate willingness into actual uptake.