Purpose: There is a critical push toward addressing equity in health care. Community coalitions are uniquely situated to heed this call by tackling issues of equity and well-being that are the most relevant for their local context. This article analyzes internal and external contextual factors that may affect coalitions' prioritization of equity. Methods: Data were collected from 18 coalitions participating in a national, U.S.-based initiative aimed at strengthening community coalition work through the principles of equity and inclusion. A hybrid qualitative–quantitative method (qualitative comparative analysis [QCA]) was conducted using the direct method of calibration and fuzzy set QCA and to obtain casual sufficiency results. Results: Coalitions located in states that did not expand Medicaid after the Affordable Care Act were most likely to prioritize equity, as were coalitions who were both working with marginalized populations and had low organizational readiness for the initiative. However, only one case demonstrated the latter causal solution; the former accounts for greater coverage of the outcome. Conclusion: This study illustrates the use of QCA for evaluation and underscores the critical role of contextual factors for affecting meaningful community-level change. Coalitions are willing and able to prioritize tackling health inequities across settings, but those in settings with low state-level support may be more likely to emphasize inequities in their work.

Transforming communities to be healthier and more equitable prosents a systemic challenge best addressed by those with native knowledge of the system. Community coalitions are a promising structure for tackling local health inequities, if they approach the change process with multiple local stakeholders and with systemic change in mind. Maturity models offer a framework for system assessment by defining sequential stages toward ideal development. Providing coalitions with a structure for self-assessing community change, the Community Transformation Map (CTM) is a maturity model that operationalizes concepts hypothesized to foster systemic change. This 40-item tool encourages self-assessment, dialogue, and reconciliation of community transformation priorities via an appreciative inquiry process. The CTM was created and applied with 18 community coalitions participating in the 100 Million Healthier Lives initiative. It was iteratively drafted with representatives from across the initiative. These coalitions self-administered the CTM four times over 24 months. Coalitions used the CTM to reconcile perspectives, identify priorities, and create transformation action plans. After the fourth administration, ten semistructured interviews were conducted with coalition members. Thematic analysis revealed good contextual validity. Coalitions saw value in the CTM's productive dialogue and the shared understanding it created, but reported perceived burden in conducting repeated administration. The CTM's value is in structuring community members' reflection on complex, systemic problems. The CTM is rooted in international improvement and change principles and continues to be adapted for other change initiatives. This document is copyrighted by the American Psychological Association or one of its allied publishers.This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.