AbstractMild cognitive impairment (MCI) is characterized by mild impairment in one or more cognitive functions and isassociated with an increased risk for failure to take prescribed medications. Hypertension is prevalent amongpersons with MCI (PwMCI) and nonadherence to medications increases the risk of accelerated cognitivedecline through cerebrovascular disease. Adherence is often only 46% or lower among PwMCI. Further theCOVID-19 pandemic has resulted in the isolation of these individuals from care partners (friends family andhealthcare workers) who assist with medication management uncovering the urgent need for developing self-management tools. We have previously developed a theory-based mobile health (mHealth) system calledMedication Education Decision Support Reminding and Monitoring (MEDSReM) to support adherence incognitively normal older adults which can be adapted for PwMCI. No existing studies have evaluated thebenefits of mHealth self-management tools to support hypertension medication adherence for PwMCI. In orderfor such digital interventions to be beneficial they have to be carefully designed/adapted to meet the uniquecapabilities and limitations of PwMCI. User-centered technology has been shown to promote independenceand autonomy by compensating for lost cognitive skills. In this proposal we are poised to address the uniqueneeds for digital technology use in this at-risk population of PwMCI based on user-centered design to guide thedevelopment of Medication Education Decision Support Reminding and Monitoring-Memory (MEDSReM-M)system conduct iterative usability testing to optimize the system for PwMCI and examine the efficacy tosupport hypertension medication adherence. In Aim 1 facilitators and barriers for use of MEDSReM will beidentified by interviewing PwMCI and their care partners after they are shown the self-management system toguide the development of MEDSReM-M. Then using heuristic evaluations and cognitive walkthroughs andthrough iterative usability testing with PwMCI we will test redesign and optimize the system for PwMCI. InAim 2 we will conduct a randomized controlled trial involving 100 PwMCI to test the effects of MEDSReM-Mrelative to an standardized educational control group on outcomes including adherence to hypertensionmedications blood pressure self-determination (competence and autonomy) and technology acceptance. Wewill then test predictors of the rate of change in medication adherence over 3 months to inform future large-scale deployment. Taking a human factors approach to identify needs and requirements for technologicalsupport to take medications as intended and iterative testing for the usability of MEDSReM-M among PwMCIwith a consequent RCT will result in a digital health intervention system that has the potential to reducecognitive decline associated with cardiovascular risks save healthcare dollars and promote autonomy andquality of life in this vulnerable population.