PREFER-IT: A transdisciplinary co-created framework to realise inclusive health AI.

Artificial intelligence (AI) in healthcare holds transformative potential but risks exacerbating existing health disparities if inclusivity is not explicitly accounted for. This study addresses the disconnected discussions on inclusive health AI by developing a comprehensive framework, PREFER-IT. This framework is based on the outcomes of a five-day transdisciplinary co-creation workshop that involved 37 experts from diverse backgrounds, including healthcare, ethics, law, social sciences, AI, and patient advocacy, held in the Netherlands. For this workshop, we used design thinking and participatory methodologies to develop a framework for realising inclusive health AI. We identified three key challenges for realising inclusive health AI: integrating the lived experiences and stakeholder voices across the AI lifecycle, designing data collection practices that promote fairness and prevent inequalities, and fostering regulatory frameworks to uphold human rights and promote inclusivity. The analysis of participants' perspectives informed the development of eight key thematic clusters of PREFER-IT: Participatory and co-design approaches (P), Representative and diverse data (R), Education and digital literacy (E), Fairness (F), Ethical and legal accountability (E), Real-world validation and feedback (R), Inclusive communication (I), and Technical interoperability (T). These elements were mapped across structural layers of AI (humans, data, process, system and governance) and the AI lifecycle to guide inclusive design, development, validation, implementation, monitoring, and governance. This framework fosters stakeholder engagement and systemic change, positioning inclusion as a guiding principle in practice. PREFER-IT offers a practical and conceptual contribution for how to include ethical, legal, and societal aspects when aiming to foster responsible and inclusive AI in healthcare.