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Background: Bangladesh with its large population is highly vulnerable to the devastating blows of coronavirus disease 2019 (COVID-19) and rural people are more at risks due to demographic characteristics and unequal health facilities. Currently, focuses are more on testing and clinical management of COVID-19 but initiatives or innovations on behavioural changes are almost unseen to prevent the spread of the disease which is more urgent until getting specific treatment or vaccine. Objective: The study was aimed to determine significant predictors in the preventive health practices during COVID-19 pandemic. Methods: The study was conducted among 810 rural adults of Bangladesh in 2020. Multistage sampling method was done and data were collected through face-to-face interview using a pretested questionnaire. Significant factors of COVID-19 prevention behaviour were determined through hierarchical regression and path relationships were explained through causal model. Results: Almost half of the rural adults showed poor COVID-19 prevention behaviour during the pandemic crisis. Poor knowledge and attitude regarding COVID-19 prevention were also common scenarios in rural areas. Majority of the rural adults were not well motivated and lack of seriousness made them more vulnerable for COVID-19. Socio-demographic and regional variation showed significance predicting health practices of rural adults regarding COVID-19 prevention. Information, attitude, motivation and intention were also found significant in hierarchical regression to predict the outcome. The causal model of preventive health behaviour was justified through all the significant direct and indirect path relationships (p