Public Health Agencies' Level of Engagement in and Perceived Barriers to PHAB National Voluntary Accreditation

Objective: This study examines local health departments' (LHDs') and state health agencies' (SHAs') engagement, LHDs' perceived barriers, and factors associated with level of engagement in accreditation. Design: The study design is observational, cross-sectional, and based on census design surveys of all state and local health departments. Methods: Data from the National Association of County & City Health Officials' 2013 profile of LHDs and the Association of State and Territorial Health Officials' 2012 profile of SHAs were analyzed in 2014. Logistic regression was performed with 2 levels of engagement as the outcome variable. Results: Six percent of LHDs and 27% of SHAs had either submitted an application or statement of intent, whereas 15% of LHDs and 4% of SHAs had decided not to pursue accreditation. Significant factors associated with higher level of LHD engagement in accreditation included population size of the LHD jurisdiction, state and shared governance (vs local), MD degree of top executive, absence of a local board of health, LHD's collaboration with other organizations, per capita expenditures, and performance of 2 of the Public Health Accreditation Board accreditation prerequisites, namely, a community health improvement plan and an agency-wide strategic plan. The most frequently reported reasons for LHDs not pursuing accreditation were the time/effort required for accreditation exceeding the benefits (72%), the fee being too high (54%), and the standards exceeding the capacity of their LHD (39%). Conclusions: Accreditation is expected to provide pathways to accountability, consistency, and better fit between community needs and public health services. National strategies targeting rapid diffusion of accreditation among public health agencies should include elements that address the needs of LHDs with varying degrees of intent to pursue accreditation.