Differences in Preventive Behaviors of COVID-19 between Urban and Rural Residents: Lessons Learned from A Cross-Sectional Study in China.

Xuewei Chen,Hongliang Chen

doi:10.3390/ijerph17124437

Abstract

Purpose: The purpose of this study is to examine the differences in preventive behaviors of COVID-19 between urban and rural residents, as well as identify the factors that might contribute to such differences. Methods: Our online survey included 1591 participants from 31 provinces of China with 87% urban and 13% rural residents. We performed multiple linear regressions and path analysis to examine the relationship between rural status and behavioral intention, attitude, subjective norms, information appraisal, knowledge, variety of information source use, and preventive behaviors against COVID-19. Findings: Compared with urban residents, rural residents were less likely to perform preventive behaviors, more likely to hold a negative attitude toward the effectiveness of performing preventive behaviors, and more likely to have lower levels of information appraisal skills. We identified information appraisal as a significant factor that might contribute to the rural/urban differences in preventive behaviors against COVID-19 through attitude, subjective norms, and intention. We found no rural/urban differences in behavioral intention, subjective norms, knowledge about preventive behaviors, or the variety of interpersonal/media source use. Conclusions: As the first wave of the pandemic inundated urban areas, the current media coverage about COVID-19 prevention may not fully satisfy the specific needs of rural populations. Thus, rural residents were less likely to engage in a thoughtful process of information appraisal and adopt the appropriate preventive measures. Tailoring health messages to meet rural populations’ unique needs can be an effective strategy to promote preventive health behaviors against COVID-19.

Highlights

Studies documented that rural populations are facing health disparities due to multiple barriers such as lack of health care resources, geographic distance, and lower socioeconomic status [1,2]
We examined the factors that might contribute to the differences in preventive behaviors of COVID-19 between urban and rural residents
The results of the unadjusted models indicated that rural status was associated with lower preventive behaviors (b = −0.15, p < 0.001), lower intention (b = −0.19, p < 0.001), more negative attitude (b = −0.29, p < 0.001), lower knowledge (b = −0.18, p < 0.001), and lower information appraisal skills (b = −0.17, p < 0.001)

Summary

Introduction

Studies documented that rural populations are facing health disparities due to multiple barriers such as lack of health care resources (e.g., transportation, health insurance, providers, and facilities), geographic distance, and lower socioeconomic status [1,2]. Rural residents have higher rates of morbidity and mortality from various diseases, including cancer and cardiovascular disease [3,4,5]. Rural populations engage in preventive health behaviors less than urban populations. Preventive health behaviors refer to any activity undertaken by an individual who believes himself or herself to be healthy for the purpose of preventing disease [6]. Children living in rural areas consume less fruit and vegetable than their urban peers [7]; rural residents were less likely to wear sunscreen to prevent skin cancer than urban residents [8]; and women living in. Res. Public Health 2020, 17, 4437; doi:10.3390/ijerph17124437 www.mdpi.com/journal/ijerph

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