Introduction: The United States Centers for Disease Control and Prevention (CDC) issued behavioral recommendations to limit the spread of the novel coronavirus disease-2019 (COVID-19). No studies have examined the influence of various factors on adherence to COVID-19 preventive measures. Among individuals with co-morbidities, such as cardiovascular disease (CVD) and residing in rural communities, adherence is essential as they are at an increased risk of COVID-19 infection and increased disease severity.

Objective: This study aims to explore factors influencing adherence to evidence-based recommendations for preventing COVID-19 among patients/family caregivers with CVD in rural Central Appalachia.

Methods: During March-April 2020, 102 CVD Stakeholders - patients/family caregivers, community leaders, and providers from six states across Appalachia participated in a survey administered through REDCap. This study used a subsample (n=73) that excluded providers. Adherence score was defined as the rate of compliance with health authorities’ guidelines, including handwashing, physical distancing, staying home if sick, wearing a face mask, disinfecting and cleaning daily, and cough and sneezing etiquette. Simple and multiple linear regressions were performed to examine associations between adherence scores and variables of interest.

Results: Over half (53.42%) of participants complied with all guidelines. Gender, employment status, hypertension, smoking, no insurance, getting information about COVID-19 from Government/CDC website, and getting information about COVID-19 from worship place/club were significantly associated with adherence to CDC recommendations (p<0.05). Compared to low personal perception of threat (PPT), having no and high PPT were associated with lower and higher adherence scores, respectively (β= -2.32, 1.42; p=0.001). Compared to low perception of COVID-19 threat towards family/friends, having moderate or high perception of COVID-19 threat toward family/friends was associated with improved adherence (β= 1.3, 1.57; p<0.05 for both), whereas having no perception was negatively associated with adherence (β= -2.08, p=0.003). Moderate and high perception of COVID-19 threat toward one's community (β= 2.14, 2.06; p<0.001) were likewise associated with higher adherence. R squared for the model= 0.459.

Conclusion: Moderate and high perceptions of COVID-19 threats are associated with higher adherence, whereas no perception was associated with lower adherence with health authority recommendations for COVID-19 prevention. These factors should be considered in order to develop effective adherence interventions for CVD stakeholders in rural communities. Results should be confirmed in a larger study.