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Abstract
The pursuit of continuous quality improvement in public health by local and state health departments has been an increasingly important milestone to achieve. With this increased focus, Public Health Accreditation Board (PHAB) accreditation is a significant benchmark for establishing and maintaining quality among local and state health departments. With successive achievement tier structures, Malcolm Baldrige-type state quality award programs also effectively recognize high-achieving health departments and organizations. However, rural local health departments face geographic; population; economic; and demographic barriers to achieving accreditation and state quality awards that their urban counterparts rarely experience. This qualitative descriptive study was conducted to analyze the effects of and links between the Appalachian region's local health department's 2022 fiscal year service, the economic level of the area’s population, and the incentives and barriers that influenced departmental decisions to pursue PHAB accreditation or state quality awards. This study also analyzes the varying governmental classifications of the Appalachian states and justifies the need for research into the unique public health challenges that the region’s health departments face. Appalachia’s local and state health departments struggle for limited funding and resources to account for the devastating COVID-19 pandemic, which has presented additional challenges to servicing their target populations. This research determined that the region’s local and state governance structures and economic levels did not have a significant effect on the local health department leadership’s decision to pursue initial PHAB accreditation or state quality awards, as these decisions were autonomous to each respective department, and guided by their annual budgets and administrative priorities.