Towards Explainable Stakeholder-Aware Requirements Prioritisation in Aged-Care Digital Health

Large language model (LLM) alignment often assumes that the user interacting with a model is also the primary beneficiary of its behavior. Yet in many consequential settings, one person directs the system while another bears the consequences. We study this problem in caregiver-mediated healthcare, where parents, pet owners, and caregivers make decisions for children, animals, and older adults. We introduce an evidence-grounded benchmark spanning veterinary, pediatric, and older-adult care, and test whether AI advisors maintain appropriate care when users express clinically inferior preferences. Holding patient facts fixed, we vary stated care preferences and communication styles and evaluate both initial recommendations and multi-turn follow-up. Across frontier and open-weight models, inferior preferences substantially increase switching from appropriate to inappropriate care beyond neutral conversational drift and increase agreement with the requested action, while communication style alone has a smaller effect. These failures accumulate across turns, including on cases models initially answer correctly, and often carry moderate or severe potential harm. In matched eldercare cases, the effect of an inferior preference is similar whether it is expressed by the patient or by a caregiver. Together with models' limited tendency to elicit patient preferences in caregiver conversations, this suggests that current models are highly sensitive to expressed user preferences but less sensitive to whose preferences are represented and who bears the consequences. Our results expose a broader limitation of user-centric alignment in settings with multiple stakeholders.

AI applications are increasingly being introduced into digital health. While technical performance has advanced rapidly, successful deployment mainly depends on consumer attitudes, especially to patient-facing applications. However, most existing research examines consumer attitudes towards healthcare AI at an abstract level rather than in response to concrete artefacts. We report a mixed-methods survey study in Australia (N=275) examining consumer readiness, acceptance, trust, and risk perceptions of healthcare AI, combined with a scenario-based evaluation of an AI-generated versus clinician-written consultation summary. Participants expressed moderate optimism and strong perceived usefulness and ease of use, but also substantial concerns about accuracy, safety, and data use. In the scenario task, the AI-generated summary was strongly preferred for quality, empathy, and overall usefulness, yet identification of the AI summary was near chance. Findings show that consumers judge AI through concrete communication quality and visible human governance, underscoring the need for clinically supervised deployment frameworks beyond technical performance alone.

As Artificial Intelligence (AI) and Agentic AI become increasingly integrated across sectors such as education and healthcare, it is critical to ensure that Multi-Agent Education System (MAES) is explainable from the early stages of requirements engineering (RE) within the AI software development lifecycle. Explainability is essential to build trust, promote transparency, and enable effective human-AI collaboration. Although personas are well-established in human-computer interaction to represent users and capture their needs and behaviors, their role in RE for explainable MAES remains underexplored. This paper proposes a human-first, persona-driven, explainable MAES RE framework and demonstrates the framework through a MAES for clinical reasoning training. The framework integrates personas and user stories throughout the RE process to capture the needs, goals, and interactions of various stakeholders, including medical educators, medical students, AI patient agent, and clinical agents (physical exam agent, diagnostic agent, clinical intervention agent, supervisor agent, evaluation agent). The goals, underlying models, and knowledge base shape agent interactions and inform explainability requirements that guided the clinical reasoning training of medical students. A post-usage survey found that more than 78% of medical students reported that MAES improved their clinical reasoning skills. These findings demonstrate that RE based on persona effectively connects technical requirements with non-technical medical students from a human-centered approach, ensuring that explainable MAES are trustworthy, interpretable, and aligned with authentic clinical scenarios from the early stages of the AI system engineering. The partial MAES for the clinical scenario simulator is~open sourced here.