title: Public Health Agencies' level of engagement in and perceived barriers to PHAB National Voluntary Accreditation.
abstract: 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.
  
  
  METHODS
  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.
authors.affiliation: Department of Health Policy and Management, Jiann-Ping Hsu College of Public Health, Georgia Southern University, Statesboro (Dr Shah and Ms Williams); National Association of County & City Health Officials, Washington, District of Columbia (Ms Leep and Dr Ye); and Association of State and Territorial Health Officials, Arlington, Virginia (Drs Sellers and Liss-Levinson).
authors.forename: Gulzar H
authors.initials: GH
authors.lastname: Shah
authors.forename: Carolyn J
authors.initials: CJ
authors.lastname: Leep
authors.forename: Jiali
authors.initials: J
authors.lastname: Ye
authors.forename: Katie
authors.initials: K
authors.lastname: Sellers
authors.forename: Rivka
authors.initials: R
authors.lastname: Liss-Levinson
authors.forename: Karmen S
authors.initials: KS
authors.lastname: Williams
mesh_terms: D000068:Accreditation / Q000639:trends*; D003299:Cooperative Behavior; D003430:Cross-Sectional Studies; D006801:Humans; D009111:Local Government; D011635:Public Health Administration / Q000379:methods* / Q000592:standards; D015980:Public Health Practice; D058996:Quality Improvement / Q000639:trends; D014481:United States