PROJECT SUMMARY/ABSTRACT Patient portals are secure, online health management tools that connect patients to portions of their electronic health record and serve as the entry point for digital care in 90% of health systems. For children (0-12 years old), the patient portal is accessed by a parent or caregiver acting on the child's behalf. Geographic, financial, communication, and structural barriers that limit access to in-person care can create barriers to digital care. Inequities in portal enrollment and use may disproportionately affect children who also face limited access to in-person care, exacerbating disparities. As the patient portal is designed as the entry point for digital engagement with healthcare, it is essential to understand the factors leading to inequitable enrollment in order to promote equitable access to digital healthcare for all children. The overall goal of this study is to identify strategies to align pediatric patient portals with the expectations and needs of parents to enhance use and to ultimately improve health communication and equitable child health outcomes. In Aim 1, we will examine child, family and system-level factors associated with proxy enrollment in and use of a pediatric patient portal among children receiving care across >125 primary care practices. In Aim 2, we will conduct semi-structured interviews with caregivers who are not enrolled in a pediatric patient portal to explore expectations, and challenges regarding patient portals. With committed mentors and strong institutional support, the PI will receive mentorship, didactic education and research experience for her career development in equity- centered research methods, qualitative methods, and leadership skills, thus preparing her for a K23 application to launch a career as an independent health services researcher focused on improving child health outcomes through equitable and appropriate application of technology.