PROJECT SUMMARY Guided by the Consolidated Framework for Implementation Research (CFIR), the overall goal of this proposed supplement is to adapt the Meet ALEX intervention to patient concerns about CRC screening safety as a result of COVID-19, pilot test in 2 new primary care clinics, and examine implementation of a remote intervention in a post-pandemic clinical environment. The COVID-19 pandemic is expected to exacerbate cancer screening inequities among vulnerable patient populations. Through the parent grant, the research team has worked in 6 UF Gainesville clinics to develop an efficient workflow and support infrastructure to address the CRC screening needs of vulnerable patient populations. Stool-based testing is now being recommended to reduce the forthcoming backlog of endoscopic and radiological CRC screening exams. The Meet ALEX intervention is ideally situated to help mitigate CRC screening inequities for vulnerable patient populations by providing patient education and in-home stool testing. In Specific Aim 1, we will expand implementation of the parent grant intervention, called Meet ALEX (Agent Leveraging Empathy for Exams) to 2 UF Jacksonville clinics that serve a predominantly Black/African American and Latinx patient population. We will also pilot test a modification that addresses patient concerns about CRC screening safety related to COVID-19. We will examine whether tailoring the intervention to patient concerns about COVID-19 alters self-reported preferences for CRC screening modality (ie, colonoscopy, home stool testing) and behavior (assessed via chart review) compared with patients who receive the existing intervention. In Specific Aim 2, we will describe facilitators and barriers associated with implementing Meet ALEX as a result of COVID-19 through in-depth interviews with key stakeholders (ie, health care providers and clinic managers) from all implementing clinics (N=8) to understand changes to organizational processes and preferences for CRC screening, availability of remote counseling, and barriers and facilitators related to implementing digital interventions as a result of the pandemic. The results of this supplement will lead to the development of best practices for implementing digital cancer screening interventions to reduce CRC inequities in primary care settings affected by COVID-19.