Year of Publication



Public Health

Degree Name

Dr. of Public Health (Dr.P.H.)

Committee Chair

Tyrone F. Borders, PhD

Committee Member

Richard C. Ingram, DrPH

Committee Member

Glen P. Mays, PhD


Background. The dynamics through which governance operates and impacts performance has been the focus of scholars in recent years. This is also true in public health systems, where there is a growing tendency to understand governance mechanisms and dimensions, as illustrated in the Public Health Accreditation Board’s (PHAB’s) Domain 12, which tends to measure governance engagement in health departments. The development of Domain 12 standards and measures has undergone systematic revisions by subject matters and experts. However, there is still a need for a scientific approach to assess the validity of such measures, or examine whether they measure what they were set to measure.

Objectives. To provide an understanding of how governance, and public health governance in particular, has been operationalized and measured in the literature; what measures offer high degrees of validity; and evidence of the conformity and validity, or the lack thereof, of Domain 12 standards and measures. The project findings will enable accreditation experts in PHAB to improve their understanding and use of the standards and measures.

Methods. This study was divided into three separate papers. First, a systematic review of the literature of public health governance measures and validity studies was conducted. Second, we employed empirical data, using Chi-Square test and t-test, of health departments’ characteristics and performance in relation to Domain 12 to assess the conformance of Domain 12 measures against the existing governance structure and the type of governing entities. Third, health departments’ performance scores in Domain 12 were tested against their performance scores in the other domains (convergent validity).

Results. Surveys and questionnaires were the most commonly used instruments in the literature to evaluate governance. A large number of governance dimensions emerged but few validity studies were performed to assess these dimensions. In terms of governance conformance of PHAB’s Domain 12, the resulted associations were statistically insignificant, which indicate that there is no evidence to support the conformity of PHAB’s Domain 12 measures. As for the convergent validity study, results showed a lack of meaningful associations (few statistically significant associations) between Domain 12 measures and measures under other PHAB’s domains.

Conclusion. Although there seems to be no one particular and valid measure of governance with the various governance measures and few validity studies that the literature yielded, the literature review may assist in identifying appropriate theoretical frameworks for measuring public health governance. Also, despite the fact that the analysis of conformity and the validity study show no evidence of “valid” measures of Domain 12, other attributes must be considered such as data limitations and inadequacies in the data collection process, in addition to conducting more validity studies using different validation approaches.

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