Project Summary Spine pain is among the most common and disabling health conditions for both non-Hispanic whites (NHWs) and racial/ethnic minorities. Although Hispanics often report more severe musculoskeletal pain than NHWs, they are less likely to consult a healthcare professional for pain management, and health care providers are less likely to assess and treat pain in Hispanic patients. The overall objective of this proposal is to adapt and test evidence-based, culturally informed practices at multiple levels of influence along the healthcare continuum to improve access to and engagement in physical rehabilitation as a non-pharmacological treatment option for Hispanics with spine pain. Aim 1 proposes a mixed-methods approach to adapt and manualize a multilevel intervention to address modifiable factors contributing to ethnic disparities in rates of physician referral and patient adherence to physical therapy referral for spine pain in a Federally Qualified Health Center (FQHC) serving diverse, low-income communities near the US-Mexico border. Aim 2 will then assess effectiveness of the manualized intervention, referred to as STEPPT (Salud de tu Espalda: Primary Care to Physical Therapy), using a cluster-randomized stepped-wedge clinical trial in the FQHC setting. Compared to standard care, we hypothesize that STEPPT will significantly reduce ethnic disparities in rates of physician referral and patient adherence to physical therapy referral for spine pain. Successful completion of the proposed aims will provide underserved Hispanic communities with scalable, sustainable, and effective options for engaging in culturally appropriate pain care. This approach can serve as a model for FQHCs and other healthcare systems to mitigate disparities in specialty services for a variety of health conditions that disproportionately impact ethnic and racial minorities.