title: It's Not Just a Yes or No Answer: Expressions of Local Health Department Accreditation.
abstract: The identification and exploration of moderators of health department accreditation remain limited by current dichotomous conceptualizations of pursuit.
  
  
  METHODS
  A 2015 survey measured Indiana local health department (LHD) accreditation pursuit and progress, classifying respondents by progress evidence. Covariates included attitudes about the future impact of accreditation on funding and performance, health department size, geography, health outcome ranking, and quality improvement (QI) programing.
  
  
  RESULTS
  Four classifications of accreditation pursuit emerged and were found to have greater association with covariates than standard dichotomous measures. "Active Pursuit" was associated with formal QI programing and a belief that accreditation will impact future funding and performance. "Intent Only" was associated with no QI programing and no completion of accreditation prerequisites. "Discontinued" was associated with the belief that accreditation will not impact future performance. "Not Pursuing" was associated with no interest or plan to complete prerequisites and reported belief that accreditation will not impact future health department funding or performance.
  
  
  CONCLUSIONS
  More granular characterizations of accreditation pursuit may improve understanding of influential factors. This measurement framework should be validated in studies of LHDs in other states.
authors.affiliation: Department of Applied Health Science, Indiana University School of Public Health-Bloomington , Bloomington, IN , USA.
authors.forename: Beth E
authors.initials: BE
authors.lastname: Meyerson
authors.affiliation: Indiana Public Health Association , Indianapolis, IN , USA.
authors.forename: Jerry
authors.initials: J
authors.lastname: King
authors.affiliation: The Polis Center, Indiana University-Purdue University at Indianapolis , Indianapolis, IN , USA.
authors.forename: Karen
authors.initials: K
authors.lastname: Comer
authors.affiliation: College of Health and Human Sciences, Purdue University , West Lafayette, IN , USA.
authors.forename: Sandra S
authors.initials: SS
authors.lastname: Liu
authors.affiliation: Department of Applied Health Science, Indiana University School of Public Health-Bloomington , Bloomington, IN , USA.
authors.forename: Laura
authors.initials: L
authors.lastname: Miller
keywords: local health departments; performance improvement; public health accreditation; public health administration; public health organizational development