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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\u2019 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.<\/jats:p>","DOI":"10.1371\/journal.pdig.0001096","type":"journal-article","created":{"date-parts":[[2026,9,23]],"date-time":"2026-09-23T17:38:24Z","timestamp":1790185104000},"page":"e0001096","update-policy":"https:\/\/doi.org\/10.1371\/journal.pdig.corrections_policy","source":"Crossref","is-referenced-by-count":0,"title":["PREFER-IT: A transdisciplinary co-created framework to realise inclusive health AI"],"prefix":"10.1371","volume":"5","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4460-4549","authenticated-orcid":true,"given":"Patr\u00edcia","family":"Pita Ferreira","sequence":"first","affiliation":[{"name":"ELSA AI lab Northern Netherlands","place":["Groningen, The Netherlands"]},{"name":"University Medical Center Groningen, University of Groningen","place":["Groningen, The Netherlands"],"department":["Department of Human Movement Sciences"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-5685-8987","authenticated-orcid":true,"given":"Sara","family":"Soriano Longar\u00f3n","sequence":"additional","affiliation":[{"name":"ELSA AI lab Northern Netherlands","place":["Groningen, The Netherlands"]},{"name":"University Medical Center Groningen, University of Groningen","place":["Groningen, The Netherlands"],"department":["Department of Health Psychology"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wiam","family":"Bouisaghouane","sequence":"additional","affiliation":[{"name":"ELSA AI lab Northern Netherlands","place":["Groningen, The Netherlands"]},{"name":"Beatrix Children\u2019s Hospital, University Medical Center Groningen, University of Groningen","place":["Groningen, The Netherlands"],"department":["Department of Neonatology"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jetse","family":"Goris","sequence":"additional","affiliation":[{"name":"Independent Researcher","place":["Groningen, The Netherlands"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-5308-4211","authenticated-orcid":true,"given":"Anne H.","family":"Hoekman","sequence":"additional","affiliation":[{"name":"Information Management Healthcare, University Medical Center, University of Groningen","place":["Groningen, The Netherlands"],"department":["Department of Health Information Office"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bal\u00e1zs","family":"Markos","sequence":"additional","affiliation":[{"name":"ELSA AI lab Northern Netherlands","place":["Groningen, The Netherlands"]},{"name":"University of Groningen","place":["Groningen, The Netherlands"],"department":["STeP Research Group, Department of Transboundary Legal Studies, Faculty of Law"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9899-0265","authenticated-orcid":true,"given":"Benjamin","family":"Maus","sequence":"additional","affiliation":[{"name":"Malm\u00f6 University","place":["Malm\u00f6, Sweden"],"department":["Department of Computer Science and Media Technology"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giorgia","family":"Pozzi","sequence":"additional","affiliation":[{"name":"Delft University of Technology","place":["Delft, The Netherlands"],"department":["Faculty of Technology, Policy and Management"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hadi","family":"Hasan","sequence":"additional","affiliation":[{"name":"ELSA AI lab Northern Netherlands","place":["Groningen, The Netherlands"]},{"name":"University of Groningen","place":["Groningen, The Netherlands"],"department":["Faculty of Law"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Indre","family":"Kalinauskait\u00e9","sequence":"additional","affiliation":[{"name":"University Medical Center Utrecht","place":["Utrecht, The Netherlands"],"department":["Department of Global Public Health and Bioethics, Julius Center for Health Sciences and Primary Care"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jon\u00e1h","family":"Stunt","sequence":"additional","affiliation":[{"name":"Leiden University Medical Center","place":["Leiden, The Netherlands"],"department":["Department of Public Health and Primary Care"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1128-8487","authenticated-orcid":true,"given":"Joosje","family":"D. 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