**5. Conclusions**

For decades, public health professionals have relied on and continue to use the HBM to understand peoples' health behaviors. Whether it is receiving the COVID-19 vaccine and booster or wearing a mask in public places, understanding the public's view in their susceptibility of contracting the disease, the severity the disease will have on their personal lives, and the value placed on mitigation strategies, greatly assists public health nurses and health departments. They are able to align their educational and resource outreach programs to those who may have low perceptions of the severity COVID-19 can have on their lives, their low perceptions of the susceptibility they may have in contracting or spreading the disease, and most importantly, those who may not perceive the mitigation strategies to be beneficial to themselves and those in their family or community. In this study, we found that rural people consider mitigations strategies more effective as compared to their urban/suburban counterparts. While other studies have found rural areas tend to partake in mitigation strategies at a lower clip, we posit those same rural areas might still believe in the efficacy of the strategies. One under-resourced yet passionate messenger to close the gap between mitigation perceptions and partaking in the mitigation strategy is the local public health nurse. Public health nurses have a plethora of information as well as the passion to serve their communities. Understanding their community's perceptions of COVID-19 is the first step in addressing the ongoing need for further education and disease prevention strategies. Finally, after years of divestment, it is recommended to bolster funding to rural LHD's in order to hire more RN's. LHD RN's in rural areas are the lifeblood and key to success in navigating the pandemic now and in the future.

**Author Contributions:** Conceptualization, A.M.B., A.G., E.M.W. and A.J.P.; methodology, A.M.B. and A.G.; formal analysis, A.G. and A.M.B.; investigation, A.M.B., A.J.P., A.G. and E.M.W.; writing original draft preparation, A.M.B.; writing—review and editing, A.M.B., A.J.P., A.G. and E.M.W.; project administration, A.M.B.; funding acquisition, A.M.B. All authors have read and agreed to the published version of the manuscript.

**Funding:** The National Cancer Institute of the National Institutes of Health funded this research, grant number R01CA211323. The National Cancer Institute of the National Institutes of Health funded the APC. Dr. Wiedenman is supported by a training grant from the National Cancer Institute of the National Institutes of Health under award number T32CA190194. Amanda Gilbert is supported by a training grant of the National Heart, Lung, and Blood institute grant number T32HL130357.

**Institutional Review Board Statement:** The Institutional Review Board at Washington University in St. Louis approved the study with an exempt status (IRB#202008147). The study was conducted according to the guidelines of the Declaration of Helsinki, and approved by the Institutional Review Board (or Ethics Committee) of Washington University in St. Louis (protocol code 202008147 and date of approval 25 August 2020).

**Informed Consent Statement:** Informed consent was obtained from all subjects involved in the study.

**Data Availability Statement:** The data are not publicly available due to privacy concerns.

**Acknowledgments:** The authors would like to thank Ross C. Brownson and the faculty and staff at the CDC funded Prevention Research Center at Washington University in St. Louis (U48DP006395) for their support. The authors would also like to thank Mary Adams and Linda Dix for their administrative support.

**Conflicts of Interest:** The authors declare no conflict of interest. The funders had no role in the design of the study; in the collection, analyses, or interpretation of data; in the writing of the manuscript, or in the decision to publish the results.

#### **References**

