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This paper examines the experience of 14 Aligning Forces for Quality (AF4Q) alliances (data from additional alliances that joined the AF4Q initiative in 2009-2010 are not included in this analysis). This study’s target population included AF4Q alliance leaders, project directors, and disparities/equity staff leads who were selected based upon their overall roles in their alliance, and because they had broad and specific knowledge about challenges and strategies to reduce disparities in their communities