Less than half of all positive fecal immunochemical testing (FIT)s are followed-up by colonoscopy, thus limiting the full potential of colorectal cancer (CRC) screening to reduce mortality. Given the need for coordination in order to achieve high rates of follow-up, multilevel approaches are needed. Such approaches could be particularly beneficial in communities and populations that experience cancer disparities and have fewer specialty providers, but most data focuses on large systems or urban areas. The academic-community health system collaboration is uniquely poised to address this research and service gap. The persistent poverty and health disparities in rural Southern Illinois set the stage for truly impactful research. The investigators' approach will serve as a model for multilevel interventions in rural settings, inform future work addressing other health disparities, and fill a gap in rigorous trials of CRC screening follow-up in rural areas.

Inclusion Criteria for Primary Care Clinic Sites

• Physician Hospital Organization (PHO) affiliated with Southern Illinois Healthcare

Exclusion Criteria for Primary Care Clinic Sites

• Not a part of the PHO

Inclusion Criteria for Physicians and Staff at Primary Care Clinic Sites

• Employment at the relevant clinic at the time of the study

Exclusion Criteria for Physicians and Staff at Primary Care Clinic Sites

• Not employed at the relevant clinic at the time of the study

Inclusion Criteria for Patients

• Age 45-75 during the study period
• Must be patient of the selected primary care clinic sites

Exclusion Criteria for Patients

• Younger than 45 years of age or older than 75 years of age during the study period
• Not a patient of the selected primary care clinic sites

Inclusion Criteria for Community Members

• Age 45-75 at the time of the health fair or screening event
• Able to undergo stool testing as determined by SIH staff at the health fair or screening event

Exclusion Criteria for Community Members

• Younger than 45 years of age or older than 75 years of age
• Unable to undergo stool testing