Poorly tailored public-health messaging could play a role in lower rural mask-wearing rates

The coronavirus pandemic is disproportionately hitting rural America, where the population is older, sicker, and at a greater risk of poor outcomes from the infection. The Centers for Disease Control and Prevention recommends wearing a face mask to reduce disease transmission, but rural residents are less likely than the general populace to do it.

"This may be partly due to public health messaging that hasn’t been tailored to rural communities," Nickloas Zaller and George Pro report for Stat. "Retention of health messaging is lower in rural areas than it is in urban or suburban areas, suggesting that there is no such thing as a one-size-fits-all approach when it comes to disseminating crucial health information to the public."

One big problem: many rural people believe their risk of catching the coronavirus is relatively low. That perception may increase skepticism toward and noncompliance with mask mandates or recommendations, and it may be partially responsible for the current rural spike in cases. "The current and projected increases in covid-19 cases in rural areas may have resulted from people not following recommended preventive measures during the summer months when covid-19 cases in these areas had not yet made headlines," Zaller and Pro report.

Stat did some data-crunching to explore that hypothesis, which you can read more about in their story, but here's the upshot: "We found that intentions to wear a mask became significantly less likely as the level of rurality increased, even after adjusting for daily covid-19 incidence during the two weeks before the mask survey," Zaller and Pro report. "This is consistent with our findings that many rural counties were not experiencing significant covid-19 outbreaks during the summer and many of these counties had lower proportions of residents reporting regular mask-wearing."

Public-health messaging could help increase mask-wearing in rural areas, but it must be done correctly. "Public health messaging is not monolithic. It must be tailored to communities, recognizing cultural norms and engaging local community leaders in its dissemination. For example, distrust of medical providers and outsiders can be a norm embedded within the culture of some rural communities," Zaller and Pro report. "Mask-wearing in rural communities, like other preventive behaviors, does not occur in a social vacuum. It is critically important to understand local community norms and values to effectively disseminate life-saving public health messaging."