Currently submitted to: JMIR Human Factors
Date Submitted: Jun 21, 2026
Open Peer Review Period: Jun 30, 2026 - Aug 25, 2026
(currently open for review)
Warning: This is an author submission that is not peer-reviewed or edited. Preprints - unless they show as "accepted" - should not be relied on to guide clinical practice or health-related behavior and should not be reported in news media as established information.
Feasibility and Usability of Codesigned Culturally Appropriate Conversational Agent to Support Self -Care (DESI-Heart) In People with Cardiovascular Diseases: A Single-Arm Pilot Study
ABSTRACT
Background:
Cardiovascular diseases (CVDs) are a leading cause of morbidity and mortality worldwide, including in Australia. Effective self-care is critical for managing CVDs, yet many individuals face barriers such as complex treatment regimens, limited health literacy, and insufficient culturally appropriate support. Conversational agents (CAs) offer AI-driven, voice-based assistance to promote self-care, but most are designed for mainstream populations and do not address the specific needs of culturally diverse communities. To address this gap, we co-designed DESI-Heart, a culturally tailored conversational agent aimed at supporting self-care among Indian Australians with CVDs
Objective:
To evaluate the feasibility and usability of DESI-Heart, an 8-week CA-delivered self-care program for Indian Australians living with CVDs.
Methods:
Co-designed with the target population, the 8-week DESI-Heart program comprised four culturally and linguistically tailored modules: (1) medication reminders, (2) daily exercise guidance, (3) diet buddy, and (4) guided meditation. A single-arm pre-post pilot trial design (n=28) was used to assess the feasibility and usability of the DESI-Heart program. After completing the pretest assessments, participants accessed DESI-Heart through a web-based CA, available on smartphones or laptops. According to their preferred schedules, participants received links to the relevant modules, delivered at four time points each week over an 8-week period. Upon completion of the program, participants were invited to complete a follow-up session, which included post-test assessments and qualitative feedback on their experience using DESI-Heart.
Results:
The DESI-Heart program demonstrated feasibility. Recruitment targets were achieved, although the recruitment period exceeded by 12 weeks. Retention was high (89%, 25/28), and attrition (10.7%, 3/28) remained below the predefined feasibility threshold. Program completion rates indicated good engagement, with participants completing 74.48% (132.6/160 sessions) of prescribed sessions. Usability was rated highly (Bot Usability Score mean = 88.23), supported by sustained platform engagement. Preliminary pre-post analyses showed statistically significant changes in medication adherence, self-care maintenance and monitoring, physical and psychological quality of life (QoL), and overall QoL.
Conclusions:
The co-designed DESI-Heart program demonstrated feasibility as a culturally appropriate, digitally delivered self-care intervention for Indian Australians with CVD. Satisfactory recruitment, high participant retention, low attrition, strong program completion, and high usability collectively support progression to a larger-scale evaluation trial. Clinical Trial: NA
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