Context
Accreditation of local health departments has been identified as a crucial strategy for strengthening the public health infrastructure. Rural local health departments face many challenges including lower levels of staffing and funding than LHDs 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 rural local health department (RHLD) perspective.
Design
Qualitative analysis of semi-structured key informant interviews with Missouri LHDs serving rural communities.
Participants
Eleven administrators of RLHDs, seven from accredited and four from unaccredited departments were interviewed. Population size served ranged from 6,400 to 52,000 for accredited RLHDs and 7,200 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 significantly more incentives then 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 a RLHD to pursue voluntary accreditation. Those who pursue are likely to see benefits after the fact, but those who do not, do not see the immediate and direct benefits of voluntary accreditation. The findings from this study of state-level accreditation in Missouri provides insight that can be translated to national accreditation.