The COVID-19 pandemic has had devastating effects on Black and rural populations with a mortality rate among Blacks three times that of Whites and both rural and Black populations experiencing limited access to COVID-19 resources. The primary purpose of this study was to explore the health, financial, and psychological impact of COVID-19 among rural White Appalachian and Black nonrural central Kentucky church congregants. Secondarily we sought to examine the association between sociodemographics and behaviors, attitudes, and beliefs regarding COVID-19 and intent to vaccinate. We used a cross sectional survey design developed with the constructs of the Health Belief and Theory of Planned Behavior models. The majority of the 942 respondents were ≥36 years. A total of 54% were from central Kentucky, while 47.5% were from Appalachia. Among all participants, the pandemic worsened anxiety and depression and delayed access to medical care. There were no associations between sociodemographics and practicing COVID-19 prevention behaviors. Appalachian region was associated with financial burden and delay in medical care (p = 0.03). Appalachian respondents had lower perceived benefit and attitude for COVID-19 prevention behaviors (p = 0.004 and <0.001, respectively). Among all respondents, the perceived risk of contracting COVID was high (54%), yet 33.2% indicated unlikeliness to receive the COVID-19 vaccine if offered. The COVID-19 pandemic had a differential impact on White rural and Black nonrural populations. Nurses and public health officials should assess knowledge and explore patient's attitudes regarding COVID-19 prevention behaviors, as well as advocate for public health resources to reduce the differential impact of COVID-19 on these at-risk populations.

Original languageEnglish
Pages (from-to)767-775
Number of pages9
JournalResearch in Nursing and Health
Issue number5
StatePublished - Oct 2021

Bibliographical note

Funding Information:
This research was supported by funding provided by the University of Kentucky Vice President of Research Office, Diabetes & Obesity Priority Area and supported by the NIH National Center for Advancing Translational Sciences through grant number UL1TR001998.

Publisher Copyright:
© 2021 The Authors. Research in Nursing & Health published by Wiley Periodicals LLC.


  • COVID-19
  • Health Belief Model
  • Theory of Planned Behavior
  • health equity

ASJC Scopus subject areas

  • Nursing (all)


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