title: Barriers and Incentives to Rural Health Department Accreditation.
abstract: BACKGROUND
  Accreditation of local health departments has been identified as a crucial strategy for strengthening the public health infrastructure. Rural local health departments (RLHDs) face many challenges including lower levels of staffing and funding than local health departments serving metropolitan or urban areas; simultaneously their populations experience health disparities related to risky health behaviors, health outcomes, and access to medical care. Through accreditation, rural local health departments can become better equipped to meet the needs of their communities.
  
  
  OBJECTIVE
  To better understand the needs of communities by assessing barriers and incentives to state-level accreditation in Missouri from the RLHD perspective.
  
  
  METHODS
  Qualitative analysis of semistructured key informant interviews with Missouri local health departments serving rural communities.
  
  
  METHODS
  Eleven administrators of RLHDs, 7 from accredited and 4 from unaccredited departments, were interviewed. Population size served ranged from 6400 to 52,000 for accredited RLHDs and from 7200 to 73,000 for unaccredited RLHDs.
  
  
  RESULTS
  Unaccredited RLHDs identified more barriers to accreditation than accredited RLHDs. Time was a major barrier to seeking accreditation. Unaccredited RLHDs overall did not see accreditation as a priority for their agency and failed to the see value of accreditation. Accredited RLHDs listed more incentives than their unaccredited counterparts. Unaccredited RLHDs identified accountability, becoming more effective and efficient, staff development, and eventual funding as incentives to accreditation.
  
  
  CONCLUSIONS
  There is a need for better documentation of measurable benefits in order for an RLHD to pursue voluntary accreditation. Those who pursue accreditation are likely to see benefits after the fact, but those who do not pursue do not see the immediate and direct benefits of voluntary accreditation. The finding from this study of state-level accreditation in Missouri provides insight that can be translated to national accreditation.
authors: Health Services Management and Policy, College of Public Health, East Tennessee State University, Johnson City (Dr Beatty); Behavioral Science and Health Education, College for Public Health and Social Justice (Dr Mayer), and Biostatistics, College for Public Health and Social Justice, (Dr Elliott), Saint Louis University, Saint Louis, Missouri; Prevention Research Center in St. Louis, Brown School, Washington University in St. Louis, St. Louis, Missouri (Drs Brownson and Abdulloeva); Division of Public Health Sciences and Alvin J. Siteman Cancer Center, Washington University School of Medicine, Washington University in St. Louis, St. Louis, Missouri (Dr Brownson); and Missouri Institute for Community Health, Jefferson City, Missouri (Ms Wojciehowski).
authors: Kate E
authors: KE
authors: Beatty
authors: Jeffrey
authors: J
authors: Mayer
authors: Michael
authors: M
authors: Elliott
authors: Ross C
authors: RC
authors: Brownson
authors: Safina
authors: S
authors: Abdulloeva
authors: Kathleen
authors: K
authors: Wojciehowski
mesh_terms: D000068:Accreditation / Q000191:economics* / Q000592:standards*; D006801:Humans; D009111:Local Government; D008923:Missouri; D058996:Quality Improvement; D019035:Rural Health Services / Q000191:economics; D013192:Staff Development / Q000379:methods* / Q000639:trends; D000078329:Workforce