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Using the design science research paradigm along with value-sensitive design and sociotechnical systems theory, this study presents a design theory that provides actionable guidance for the generation, selection, and integration of synthetic data in digital health. Through heuristic theorizing over two design cycles, the work provides a robust theory artifact and conceptual model to ensure ethical use and improve model performance in digital health through appropriate domain adaptation, generalization, and accuracy. In addition to contributing to theoretical knowledge, this research offers practical implications for health authorities to promote ethical standards and performance in synthetically trained AI applications.<\/jats:p>","DOI":"10.1145\/3757308.3757311","type":"journal-article","created":{"date-parts":[[2025,7,29]],"date-time":"2025-07-29T01:18:53Z","timestamp":1753751933000},"page":"13-54","update-policy":"https:\/\/doi.org\/10.1145\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["SynthEthics: Ensuring Digital Ethics and Performance with a Design Theory for Using Synthetic Image Data in Digital Health Deep Learning"],"prefix":"10.1145","volume":"56","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6249-3184","authenticated-orcid":false,"given":"Martin","family":"B\u00f6hmer","sequence":"first","affiliation":[{"name":"Chair for Business Information Systems, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6959-9555","authenticated-orcid":false,"given":"Stephan","family":"Kuehnel","sequence":"additional","affiliation":[{"name":"Chair for Business Information Systems, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8966-5524","authenticated-orcid":false,"given":"Johannes","family":"Damarowsky","sequence":"additional","affiliation":[{"name":"Chair for Business Information Systems, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6511-221X","authenticated-orcid":false,"given":"Alfred Benedikt","family":"Brendel","sequence":"additional","affiliation":[{"name":"Department for Operations &amp; Decision Technologies, Indiana University, Bloomington, IN, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"320","published-online":{"date-parts":[[2025,7,28]]},"reference":[{"key":"e_1_2_1_1_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10676-006-9129-8"},{"key":"e_1_2_1_2_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10796-021-10193-x"},{"key":"e_1_2_1_3_1","doi-asserted-by":"publisher","DOI":"10.1186\/s40537-021-00444-8"},{"key":"e_1_2_1_4_1","volume-title":"Key strategies for synthetic data generation for training intelligent systems based on people detection from omnidirectional cameras. 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