Multi-sectoral health care alliances (MHCAs) are organizations that bring together diverse stake- holders to work collaboratively to improve health and health care in local communities. MHCA awareness is a necessary condition for cultivating and sustaining coordinated efforts among participants to improve the quality of care in a community, yet little research has examined whether MHCAs have actually fostered high levels of awareness among participants or how they go about doing so. This mixed method study used quantitative data drawn from three rounds of survey data from MHCA participants to assess the degree of MHCA awareness. It also examined whether perceptions of leadership effectiveness and management style were associated with differences in awareness at the level of the individual alliance participant, member organizations, and the community at large. Interviews with participants examined the approaches undertaken by MHCAs to foster awareness among individuals, organizations, and the community at large as well as the challenges MHCAs confront in raising awareness at each of these different levels. Findings indicate higher levels of awareness among individual participants, while awareness was perceived to be lowest at the community level. Perceptions of leadership effectiveness exhibited the most robust relationships across these three levels; it was positively associated with individual and community-level awareness. The qualitative analysis identified variations in the strategies being used and the challenges arising at the different levels and indicated that awareness building occurred sequentially across these levels, suggesting a need for more systemic approaches to promoting awareness of these alliances and their efforts.