PROJECT SUMMARY Major U.S. health systems are introducing healthcare-based (HCB) social risk interventions to foster better care, better health, and lower costs. These include screening tools to identify patients' social risks, like housing instability and food insecurity, and guide them to relevant community resources. Patients' with identified social risks often do not ask for help or decline HCB assistance with social risks. Little is known about patients' views regarding HCB social risk interventions, including factors affecting patients' decisions to engage with them. My proposed study begins to address this gap by investigating what factors may affect patients' decisions and perspectives regarding a HCB social risk intervention in AHRQ priority populations (low-income, rural, and elderly patients) across diverse healthcare settings. The intervention under investigation, the Accountable Health Communities (AHC) Model, was developed by the Centers for Medicare and Medicaid Services (CMS). The AHC Model identifies Medicare and Medicaid patients' social risks using a screening tool, and seeks to address these risks through referral to community resources. CMS is investigating whether the AHC Model will impact healthcare costs and reduce healthcare utilization. Studying the patient perspective is not an explicit focus of CMS's evaluation of the AHC Model. In Oregon, the Oregon Rural Practice-based Research Network (ORPRN) at Oregon Health & Science University (OHSU) is funded by CMS to implement the AHC Model. ORPRN has recruited 49 healthcare sites (primary care clinics, emergency departments) across 12 counties to pilot test the intervention. ORPRN provides sites with technical assistance and oversees data collection. Data for both study aims of my proposed dissertation research leverages this work underway within ORPRN. The proposed study uses a sequential explanatory mixed methods design to add the patient perspective to our understanding of HCB social risk interventions. A quantitative phase (Aim 1) will assess associations between patient characteristics and their decisions to engage with the AHC Model. A qualitative phase (Aim 2) will collect patients' views to help explain the quantitative results, and capture patients' recommendations for HCB social risk interventions. I will then integrate the quantitative and qualitative results, and collaborate with mentors who bring health policy expertise to contextualize integrated findings within Oregon's healthcare landscape to develop high-level, actionable recommendations for more patient-centered HCB social risk interventions. The proposed study will contribute to filling a critical knowledge gap regarding these interventions, particularly among patients who are more likely to experience poor health due to social risks. My training and mentorship in mixed methods and community-engaged research make me well positioned to carry out this project, and to disseminate findings using both traditiona...