Cardiovascular disease (CVD) represents a large portion of the burden of illness for industrial nations, and biomedical research has implicated lifestyle choices and socioeconomic conditions as primary determinants of CVD. There has been a resultant shift from curative to preventive and population health promoting strategies to reduce this burden of illness. The present research is part of a larger research program, the Canadian Heart Health Initiative-Ontario Project (CHHIOP), a two-stage (quantitative and qualitative) longitudinal study designed to investigate and strengthen community-based heart health activities in both the formal and informal public health systems. This study builds upon CHHIOP's qualitative findings to examine how community relationships and community development approaches play out in local contexts to shape the reality of (heart) health promotion practice. Although community development is a central concept in heart health policy there has been no analysis of its understanding, support or use among community health stakeholders. In order to address these questions thirty key informant interviews were conducted with community heart health stakeholders from eight of the 42 health unit areas across Ontario. The findings reveal that three patterns of community heart health practice appeared across the communities, illustrating a continuum of collaboration. These patterns are typfied by different community atmospheres for collaboration, the divergent nature of agency inter-relations, and distinct composites in the use of community (development) approaches. Central themes across communities illustrated the importance of local community contexts, the lack of a common understanding of community development, and the emergence of a shift in health agencies' ways of doing business. Local perspectives and the dynamics of intra-community relations were allowed to emerge and highlight the need for place-sensitive implementation of health promotion strategies at the community level. / Thesis / Master of Arts (MA)