Objective  To examine mask wearing and replacing behavior and its influencing factors among rural residents in China during the epidemic of coronavirus disease 2019 (COVID-19) for providing evidence to develop preventive measures against COVID-19 epidemic.

  Methods  With a self-designed questionnaire and multistage random cluster sampling, we conducted a face-to-face interview among 3 864 permanent residents aged ≥ 15 years recruited from 36 villages in three provinces (Shandong, Shanxi and Yunnan) located at eastern, central and western region of China from July through December 2021.

  Results  Among the 3 832 rural residents finally included in the analysis, 3 586 (93.58%) reported mask-wearing during the period of COVID-19 epidemic. Of the residents reporting mask-wearing, only 1 594 (44.45%) reported being able to do mask replacement every 4 hours. Unconditional multivariate logistic regression analyses revealed that the residents being female and with the education of primary school and above were more likely to wear mask during the epidemic; while the residents aged ≥ 35 years, being unemployed, and living in regions of Shanxi or Yunnan province were less likely to wear mask. The analyses also demonstrated that the residents being female, with the education of junior high school and above, working in enterprises or government departments, and being retired were more likely to do mask replacement in time; but the residents aged ≥ 35 years, being divorced or widowed, and living in regions of Shanxi or Yunnan province were less likely to do mask replacement in time.

  Conclusion  During the epidemic period of COVID-19, the proportion of Chinese rural residents who wore masks was high, but the proportion of timely-mask replacement was low. Gender, age, education level, occupation and living region are common influencing factors for Chinese rural residents to wear and replace masks during the period.