{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,29]],"date-time":"2026-10-29T18:20:09Z","timestamp":1793298009035,"version":"4.5.0"},"reference-count":53,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T00:00:00Z","timestamp":1785369600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Digit. Health"],"abstract":"<jats:p>\n                    Digital health has accelerated rapidly through advances in telemedicine, wearable technologies, artificial intelligence (AI), remote monitoring, and interoperable healthcare infrastructures. Despite these developments, substantial inequities persist among underserved populations, including rural and remote communities, older adults, low-socioeconomic groups, and geographically isolated populations exposed to infrastructure disruptions caused by avalanches, landslides, storms, flooding, or prolonged power outages. Current digital health approaches frequently emphasize technological innovation and connectivity while underestimating the importance of trust, contextual adaptation, resilience, health literacy, and human guidance. This\n                    <jats:italic>Perspective<\/jats:italic>\n                    argues that equitable digital health requires a shift from isolated AI tools in primary health services toward resilient\n                    <jats:italic>symbiotic health ecosystems<\/jats:italic>\n                    in which clinicians, patients, caregivers, communities, and AI systems collaboratively support healthcare delivery. Building on emerging research on symbiotic intelligence, health empowerment, telemedicine, rural resilience, and trustworthy AI, we propose a conceptual perspective in which calibrated human\u2013AI collaboration becomes central to equitable healthcare delivery. The article discusses how resilient and locally adaptive infrastructures\u2014including telemedicine, wearable monitoring, low-risk diagnostic technologies, local AI systems, backup energy systems, drones for medicine delivery, local Wi-Fi preparedness, and community-supported transport models\u2014may strengthen healthcare preparedness and continuity in underserved and disrupted contexts. Although several examples are drawn from Norway and rural Nordic contexts, the conceptual framework is intended to be transferable to underserved populations globally. Finally, this Perspective highlights the need for implementation-oriented, equity-centered, and epistemically transparent approaches to future digital health ecosystems, exemplified through five models.\n                  <\/jats:p>","DOI":"10.3389\/fdgth.2026.1885289","type":"journal-article","created":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T04:21:58Z","timestamp":1785385318000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":1,"title":["Symbiotic AI and equitable digital health: toward trustworthy and inclusive health ecosystems"],"prefix":"10.3389","volume":"8","author":[{"given":"Rune Johan","family":"Krumsvik","sequence":"first","affiliation":[{"name":"Faculty of Psychology, University of Bergen","place":["Bergen, Norway"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vegard","family":"Slettvoll","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, University of Bergen","place":["Bergen, Norway"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,7,30]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"e17450179279732","DOI":"10.2174\/0117450179279732231211110248","article-title":"Telemedicine, e-health, and digital health equity: a scoping review","volume":"20","author":"Petretto","year":"2024","journal-title":"Clin Pract Epidemiol Ment Health"},{"key":"B2","volume-title":"Equity Across the Regulation, Implementation and Evaluation of Digital Health Systems. Scoping Review","year":"2024"},{"key":"B3","doi-asserted-by":"publisher","first-page":"106051","DOI":"10.1016\/j.ijmedinf.2025.106051","article-title":"Bridging the digital divide: artificial intelligence as a catalyst for health equity in primary care settings","volume":"204","author":"Osonuga","year":"2025","journal-title":"Int J Med Inf"},{"key":"B4","doi-asserted-by":"publisher","first-page":"67","DOI":"10.18261\/njdl.20.2.1","article-title":"Symbiotic intelligence and supervision in the education sector: the need for epistemological, conceptual and research-based clarifications","volume":"20","author":"Krumsvik","year":"2025","journal-title":"Nord J Digit Lit"},{"key":"B5","doi-asserted-by":"publisher","first-page":"637","DOI":"10.1007\/s12599-019-00595-2","article-title":"Hybrid intelligence","volume":"61","author":"Dellermann","year":"2019","journal-title":"Bus Inf Syst Eng"},{"key":"B6","doi-asserted-by":"publisher","first-page":"18","DOI":"10.1109\/MC.2020.2996587","article-title":"A research agenda for hybrid intelligence: augmenting human intellect with collaborative, adaptive, responsible, and explainable artificial intelligence","volume":"53","author":"Akata","year":"2020","journal-title":"Computer (Long Beach Calif)"},{"key":"B7","doi-asserted-by":"publisher","first-page":"Article 310","DOI":"10.1186\/s12911-020-01332-6","article-title":"Explainability for artificial intelligence in healthcare: a multidisciplinary perspective","volume":"20","author":"Amann","year":"2020","journal-title":"BMC Med Inform Decis Mak"},{"key":"B8","doi-asserted-by":"publisher","first-page":"103655","DOI":"10.1016\/j.jbi.2020.103655","article-title":"The role of explainability in creating trustworthy artificial intelligence for health care: a comprehensive survey of the terminology, design choices, and evaluation strategies","volume":"113","author":"Markus","year":"2021","journal-title":"J Biomed Inform"},{"key":"B9","doi-asserted-by":"publisher","first-page":"20552076251365006","DOI":"10.1177\/20552076251365006","article-title":"Artificial intelligence, health empowerment, and the general practitioner scheme","volume":"11","author":"Krumsvik","year":"2025","journal-title":"SAGE Open Med"},{"key":"B10","doi-asserted-by":"publisher","first-page":"199","DOI":"10.1177\/10608265231207997","article-title":"The relationship between masculinity and help-seeking among Australian men living in non-urban areas","volume":"32","author":"Piatkowski","year":"2024","journal-title":"J Men\u2019s Studies"},{"key":"B11","doi-asserted-by":"crossref","DOI":"10.1093\/oso\/9780192845290.001.0001","volume-title":"Human-Centered AI","author":"Shneiderman","year":"2022"},{"key":"B12","volume-title":"Deep Medicine: How Artificial Intelligence can Make Healthcare Human Again","author":"Topol","year":"2019"},{"key":"B13","year":"2026"},{"key":"B14","doi-asserted-by":"publisher","first-page":"1687841","DOI":"10.3389\/froh.2025.1687841","article-title":"Symbiotic intelligence in dental trauma diagnostics\u2014an exploratory case study","volume":"6","author":"Krumsvik","year":"2025","journal-title":"Front Oral Health"},{"key":"B15","doi-asserted-by":"publisher","first-page":"Article 545","DOI":"10.1186\/s12913-018-3359-4","article-title":"Will artificial intelligence solve the human resource crisis in healthcare?","volume":"18","author":"Mesko","year":"2018","journal-title":"BMC Health Serv Res"},{"key":"B16","doi-asserted-by":"publisher","first-page":"Article 122","DOI":"10.1038\/s41746-024-01151-3","article-title":"From wearable sensor data to digital biomarker development","volume":"7","author":"Daniore","year":"2024","journal-title":"npj Digit Med"},{"key":"B17","doi-asserted-by":"publisher","first-page":"410","DOI":"10.3390\/bios15070410","article-title":"AI-driven wearable bioelectronics in digital healthcare","volume":"15","author":"Huang","year":"2025","journal-title":"Biosensors"},{"key":"B18","doi-asserted-by":"publisher","first-page":"149","DOI":"10.1007\/s13167-024-00364-6","article-title":"Digital biomarkers: a predictive, preventive and personalized medicine approach to chronic disease management","volume":"15","author":"Smokovski","year":"2024","journal-title":"EPMA J"},{"key":"B19","doi-asserted-by":"publisher","first-page":"2839","DOI":"10.2147\/JMDH.S419923","article-title":"Health care equity through intelligent edge computing and augmented reality\/virtual reality: a systematic review","volume":"16","author":"Lakshminarayanan","year":"2023","journal-title":"J Multidiscip Healthc"},{"key":"B20","article-title":"Moving","author":"Watt","year":"2024"},{"key":"B21","author":"Basit","year":"2024"},{"key":"B22","author":"Mattson","year":"2023"},{"key":"B23","doi-asserted-by":"publisher","first-page":"2519137","DOI":"10.1080\/20523211.2025.2519137","article-title":"The evolution of medication delivery via drones: revolutionizing healthcare logistics","volume":"18","author":"Jairoun","year":"2025","journal-title":"J Pharm Policy Pract"},{"key":"B24","author":"Habibi","year":"2025"},{"key":"B25","volume-title":"Artificial Intelligence (AI) Technologies for Assessing and Triaging Skin Lesions Referred to the Urgent Suspected Skin Cancer Pathway: Early Value Assessment (HealthTech Guidance No. 746)","year":"2025"},{"key":"B26","doi-asserted-by":"publisher","first-page":"e35395","DOI":"10.2196\/35395","article-title":"Artificial intelligence support for skin lesion triage in primary care and dermatology","volume":"7","author":"Thompson","year":"2021","journal-title":"iProceedings"},{"key":"B27","doi-asserted-by":"publisher","first-page":"1655154","DOI":"10.3389\/fdgth.2025.1655154","article-title":"Artificial intelligence and health empowerment in rural communities and landslide- or avalanche-isolated contexts: real case at a fictitious location","volume":"7","author":"Krumsvik","year":"2025","journal-title":"Front Digit Health"},{"key":"B28","doi-asserted-by":"publisher","first-page":"1695377","DOI":"10.3389\/fdgth.2025.1695377","article-title":"Timing is survival: modeling how earlier calls improve cardiac arrest outcomes","volume":"7","author":"Johansen","year":"2025","journal-title":"Front Digit Health"},{"key":"B29","doi-asserted-by":"publisher","first-page":"e34384","DOI":"10.2196\/34384","article-title":"The impact of wearable technologies in health research: scoping review","volume":"10","author":"Huhn","year":"2022","journal-title":"JMIR Mhealth Uhealth"},{"key":"B30","doi-asserted-by":"publisher","first-page":"e56504","DOI":"10.2196\/56504","article-title":"Patterns of ownership and usage of wearable devices in the United States, 2020\u20132022: survey study","volume":"26","author":"Nagappan","year":"2024","journal-title":"J Med Internet Res"},{"key":"B31","volume-title":"Screenagers to Silver Surfers: How Each Generation Clicks with Care","year":"2025"},{"key":"B32","author":"Kumar","year":"2026"},{"key":"B33","doi-asserted-by":"publisher","first-page":"e41042","DOI":"10.2196\/41042","article-title":"Digital biomarker-based interventions: systematic review of systematic reviews","volume":"24","author":"Motahari-Nezhad","year":"2022","journal-title":". J Med Int Res"},{"key":"B34","author":"Esmaeilpour","year":"2026"},{"key":"B35","doi-asserted-by":"publisher","first-page":"Article e036801","DOI":"10.1161\/JAHA.124.036801","article-title":"Daily heart rate per step: a wearables metric associated with cardiovascular disease in a cross-sectional study of the all of Us research program","volume":"14","author":"Chen","year":"2025","journal-title":"J Am Heart Assoc"},{"key":"B36","doi-asserted-by":"publisher","first-page":"939","DOI":"10.1053\/j.gastro.2024.12.024","article-title":"Physiological data collected from wearable devices identify and predict inflammatory bowel disease flares","volume":"168","author":"Hirten","year":"2025","journal-title":"Gastroenterology"},{"key":"B37","doi-asserted-by":"publisher","first-page":"538","DOI":"10.3390\/diagnostics16040538","article-title":"Clinical evidence of wearable-derived heart rate variability for detecting systemic inflammation: a systematic review","volume":"16","author":"Siswishanto","year":"2026","journal-title":"Diagnostics"},{"key":"B38","doi-asserted-by":"publisher","first-page":"556","DOI":"10.1136\/bjsports-2023-107849","article-title":"Cardiorespiratory fitness is a strong and consistent predictor of morbidity and mortality among adults: an overview of meta-analyses representing over 20.9 million observations from 199 unique cohort studies","volume":"58","author":"Lang","year":"2024","journal-title":"Br J Sports Med"},{"key":"B39","doi-asserted-by":"publisher","first-page":"e183605","DOI":"10.1001\/jamanetworkopen.2018.3605","article-title":"Association of cardiorespiratory fitness with long-term mortality among adults undergoing exercise treadmill testing","volume":"1","author":"Mandsager","year":"2018","journal-title":"JAMA Netw Open"},{"key":"B40","doi-asserted-by":"publisher","first-page":"E53","DOI":"10.1503\/cmaj.150535","article-title":"Resting heart rate and all-cause and cardiovascular mortality in the general population: a meta-analysis","volume":"188","author":"Zhang","year":"2016","journal-title":"CMAJ"},{"key":"B41","doi-asserted-by":"publisher","first-page":"23865","DOI":"10.1038\/s41598-024-74619-7","article-title":"Assessment of heart rate measurements by commercial wearable fitness trackers for early identification of metabolic syndrome risk","volume":"14","author":"Mun","year":"2024","journal-title":"Sci Rep"},{"key":"B42","doi-asserted-by":"publisher","first-page":"245","DOI":"10.1016\/j.jacc.2023.04.054","article-title":"Consumer wearable health and fitness technology in cardiovascular medicine: jACC state-of-the-art review","volume":"82","author":"Petek","year":"2023","journal-title":"J Am Coll Cardiol"},{"key":"B43","doi-asserted-by":"publisher","first-page":"275","DOI":"10.1007\/s40279-024-02159-1","article-title":"Using free-living heart rate data as an objective method to assess physical activity: a scoping review and recommendations by the INTERLIVE-network targeting consumer wearables","volume":"55","author":"Schumann","year":"2025","journal-title":"Sports Med"},{"key":"B44","author":"Slettvoll","year":"2025"},{"key":"B45","volume-title":"Menns Bruk av Prim\u00e6rhelsetjenesten [Men\u2019s use of Primary Healthcare Services]","year":"2024"},{"key":"B46","doi-asserted-by":"publisher","first-page":"2666623","DOI":"10.1080\/02813432.2026.2666623","article-title":"General practitioner utilization by age, sex and disease in Norway from 2012 to 2023: a national health registry study","volume":"44","author":"Reme","year":"2026","journal-title":"Scand J Prim Health Care"},{"key":"B47","volume-title":"GPS and Emergency Primary Health Care","year":"2026"},{"key":"B48","doi-asserted-by":"publisher","first-page":"15579883251321670","DOI":"10.1177\/15579883251321670","article-title":"Men's mental health matters: the impact of traditional masculinity norms on men's willingness to seek mental health support; a systematic review of literature","volume":"19","author":"Mokhwelepa","year":"2025","journal-title":"American Journal of Men\u2019s Health"},{"key":"B49","doi-asserted-by":"publisher","first-page":"15579883241241090","DOI":"10.1177\/15579883241241090","article-title":"Approaches to engaging men during primary healthcare encounters: a scoping review","volume":"18","author":"Seidler","year":"2024","journal-title":"Am J Men\u2019s Health"},{"key":"B50","doi-asserted-by":"publisher","first-page":"15579883221101274","DOI":"10.1177\/15579883221101274","article-title":"Notions about men and masculinities among health care professionals working with men's sexual health: a focus group study","volume":"16","author":"Persson","year":"2022","journal-title":"Am J Men\u2019s Health"},{"key":"B51","doi-asserted-by":"publisher","first-page":"2322","DOI":"10.59400\/jps2322","article-title":"Charting public health horizons: hybrid SMEs and the X.0 wave theory in post-COVID governance","volume":"3","author":"Mattiello","year":"2025","journal-title":"J Polit Soc"},{"key":"B52","doi-asserted-by":"publisher","first-page":"89","DOI":"10.1042\/ETLS20243003","article-title":"The impact of artificial intelligence on biomarker discovery","volume":"8","author":"Javaid","year":"2025","journal-title":"Emerg Top Life Sci"},{"key":"B53","volume-title":"Ethics and Governance of Artificial Intelligence for Health","year":"2021"}],"container-title":["Frontiers in Digital Health"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fdgth.2026.1885289\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T04:22:01Z","timestamp":1785385321000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fdgth.2026.1885289\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7,30]]},"references-count":53,"alternative-id":["10.3389\/fdgth.2026.1885289"],"URL":"https:\/\/doi.org\/10.3389\/fdgth.2026.1885289","relation":{},"ISSN":["2673-253X"],"issn-type":[{"value":"2673-253X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7,30]]},"article-number":"1885289"}}