PROJECT SUMMARY/ABSTRACT Rural-serving primary care clinics in our Colorado Implementation Science Center in Cancer Control (COISC3) seek to address inequities in behavioral cancer risks and unmet social needs. Clinics need efficient, low-cost tools to screen for and address multiple risks at the same time — and technology can provide important efficiencies. My Own Health Report (MOHR) is a web-based intervention with 3 core functions: 1) Risk Flagging; 2) Goal-setting for patient-prioritized risks; 3) Service Linkage to resources. Our prior trial found that patients receiving MOHR improved physical activity (p < 0.001) and diet (p < 0.001) behaviors that increase the risk for many types of cancer; MOHR also showed improvements in other health behaviors and a signal of reduced tobacco use (with a small n). Thus, MOHR has great potential to prevent cancer. However, we identified two key gaps. First, our COISC3 clinics voiced a need for a more flexible menu of delivery options to feasibly adopt and sustain the intervention. Second, to achieve equitable reach and effectiveness, particularly for those with unmet social needs, clinics need to provide structured follow-up. Such follow-up increases patient access to resources for behavioral risks and/or unmet social needs, thus “leveling the playing field” to address cancer risks. Our new preliminary data show clinics and patients value MOHR with structured follow- up strategies to remind patients of their goals and to provide relevant resources. We developed the infrastructure for and pilot-tested two distinct implementation strategy bundles to provide this follow-up. The first bundle, termed “Reminder-Resource message (R2 message),” involves electronic texts/e-mails sent automatically by MOHR. The second bundle, “R2 Navigation,” trains staff in each clinic to personally deliver these reminders and resources. Each strategy bundle addresses the contextual determinants of successful implementation and sustainment identified in our Pragmatic Robust Implementation and Sustainability Model (PRISM). However, the relative impact of R2 message, R2 Navigation, or their combination is unknown. In Aim 1, we will engage staff, patients, and partners in our COISC3 to finalize the implementation plans to deliver R2 message and R2 Navigation from a menu of options co-developed in preliminary workshops. In Aim 2, we will conduct a randomized comparative effectiveness-implementation trial with 1,400 adult patients with two or more cancer risks (including both insufficient physical activity and fruit/vegetable intake) across 7 COISC3 clinics to evaluate the comparative outcomes of R2 message and R2 Navigation alone or in combination. We will assess multi-level outcomes, including: 1) Effectiveness, 2) Implementation, and 3) Practice Value (including patient experience and costs). In Aim 3, we will use our iterative PRISM process to co-develop an “implementation, adaptation and sustainment guide” for the most cost-effect...