Corresponding Author

Maria L. Gomez, DrPH, MPH


Author Affiliations

1. Maria L. Gomez, DrPH, MPH: University of Kentucky College of Nursing, Lexington, KY 40536.

2. Tofial Azam, PhD: University of Kentucky Department of Biostatistics, College of Public Health, Lexington, KY 40536.

3. Jean Edward, PhD, RN: University of Kentucky College of Nursing, Lexington, KY 40536.

4. Hannah Bowman, BSN: University of Kentucky College of Nursing, Lexington, KY 40536.

5. Lovoria B. Williams, PhD, APRN, FAAN: University of Kentucky College of Nursing, Lexington, KY 40536

Author Area of Expertise

Dr. Gomez: Minority Health, Health Equity, Community Engagement, Diabetes Prevention, Cancer Prevention, Women's Health.

Dr. Azam: Biostatistics, Epidemiology, Randomized and Non-Randomized Trials, Cross-sectional, Longitudinal studies.

Dr. Ewards: Health Equity, Social Determinants of Health, Health and Insurance Literacy, Cancer-related Financial Toxicity and Hardship, Underserved Immigrants, Minority and Rural populations.

Ms. Hannah Bowman: Health Equity, Vulnerable Populations.

Dr. Williams: Faith-based interventions, Diabetes Prevention, Weight loss, Cancer Prevention, Cancer Screening Uptake, Survey research that explores health-related attitudes and beliefs.


Introduction: The COVID-19 pandemic has had detrimental impacts in non-rural Black and rural Appalachian populations. Yet despite the pandemic’s magnitude, there is a scarcity of research exploring potential influences of attitudes and social influences within these populations on their adherence to COVID-19 public health preventive behaviors.

Purpose: This study examines the intention, attitudes, and social influences to adhere to COVID-19 preventive behaviors among non-rural Black and rural Appalachian congregants in Kentucky by integrating the Theory of Planned Behavior (TPB).

Methods: Secondary analysis of cross-sectional data was used to assess the association between the TPB constructs and four key public health behaviors: obeying a stay-at-home order, social distancing, good hygiene practices, and wearing a mask in public. Generalized estimating equation-type logistic regression models were fit for all binary outcomes.

Results: A total of 942 respondents completed the survey. Eighty-nine per cent were older than 36 years, and 73% were female. Of the respondents who were White, 97.7% lived in rural Appalachia Kentucky, and of those who were Black, 93.5% lived in non-rural Kentucky. Attitude towards the behavior was negatively associated with the stay-at-home order (p=0.003). Both attitude toward the behavior (p<0.001) and the subjective norm (p=0.025) were negatively associated with mask wearing. Perceived behavioral control was positively associated with mask wearing (p=0.023) with non-rural respondents more likely to wear a mask than rural ones (p<0.001). None of the TPB constructs showed significant association with hygiene practices or with social distancing.

Implications: This study provides further insight into the cultural and societal influences that intersect during a global pandemic. The intention to comply with public health recommendations may vary at favorable and unfavorable levels. The results lend support to the importance of designing effective, culturally tailored communication for future public health preparedness.



Creative Commons License

Creative Commons Attribution 4.0 License
This work is licensed under a Creative Commons Attribution 4.0 License.

Recommended Citation

Gomez ML, Azam T, Edward J, Bowman H, Williams LB. Assessing the intention, attitudes, and social influences on COVID-19 preventive behaviors among non-rural black and rural Appalachian white populations: A faith-based community study. J Appalach Health 2022;4(2):45–64. DOI: https://doi.org/10.13023/jah.0402.05.