Trustworthy AI in Digital Health: A Comprehensive Review of Robustness and Explainability
Authors: Abdullah Mamun, Shovito Barua Soumma, Hassan Ghasemzadeh
Organizations: College of Health Solutions, Arizona State University, Phoenix, AZ, USA · School of Computing and Augmented Intelligence, Arizona State University, Tempe, AZ, USA
Abstract
Ensuring trust in AI systems is essential for the safe and ethical integration of machine learning systems into high-stakes domains such as digital health. Key dimensions, including robustness, explainability, fairness, accountability, and privacy, need to be addressed throughout the AI lifecycle, from problem formulation and data collection to model deployment and human interaction. While various contributions address different aspects of trustworthy AI, a focused synthesis on robustness and explainability, especially tailored to the healthcare context, remains limited. This review addresses that need by organizing recent advancements into an accessible framework, highlighting both technical and practical considerations. We present a structured overview of methods, challenges, and solutions, aiming to support researchers and practitioners in developing reliable and explainable AI solutions for digital health. This review article is organized into three main parts. First, we introduce the pillars of trustworthy AI and discuss the technical and ethical challenges, particularly in the context of digital health. Second, we explore application-specific trust considerations across domains such as intensive care, neonatal health, and metabolic health, highlighting how robustness and explainability support trust. Lastly, we present recent advancements in techniques aimed at improving robustness under data scarcity and distributional shifts, as well as explainable AI methods ranging from feature attribution to gradient-based interpretations and counterfactual explanations. This paper is further enriched with detailed discussions of the contributions toward robustness and explainability in digital health, the development of trustworthy AI systems in the era of LLMs, and various evaluation metrics for measuring trust and related parameters such as validity, fidelity, and diversity.
Medical Artificial Intelligence (AI) is widely expected to transform clinical practice, yet the decision-making processes of many Machine Learning (ML) models remain opaque. Explainability has been advanced as a partial remedy to clarify why AI generates predictions, particularly in high-stakes contexts. Despite ongoing efforts, debates on what constitutes an adequate medical explanation remain unsettled. Yet, explanation has long been a central topic of inquiry in the philosophy of science and medicine. The insights developed in these fields, however, have been largely overlooked in contemporary explainable AI (XAI) research, leaving its foundational assumptions insufficiently examined. To address this gap, this paper develops a critical review at the intersection of philosophy of science and XAI. It examines prevailing accounts of what counts as an explanation in the health sciences and assesses their adequacy for informing XAI in medicine, arguing that they provide necessary conditions for a philosophically grounded approach to explainability in this domain. Building on this foundational philosophical literature, the discussion identifies three central axes of analysis: the role of causality in medical reasoning, the epistemic and relational dimensions of medical trust, and the criteria of explanatory adequacy as shaped by the pragmatic needs of diverse stakeholders. By integrating philosophical analysis with current developments in medical AI, the paper outlines principles for designing XAI systems that offer explanations that are not only epistemically robust but also aligned with the epistemic and practical requirements of clinical decision-making, shaping ongoing debates in medical XAI toward underexplored conceptual foundations.
Agentic AI systems -- Large Language Models (LLMs) augmented with planning, tool use, memory, and long-horizon interactions -- can execute complex tasks autonomously, but their multi-step trajectories introduce new failure modes that challenge trustworthiness. This survey provides a focused examination of trustworthy agentic AI through two core dimensions that are critical for high-risk deployments: Safety and Robustness, and Privacy and System Security. For each dimension, we clarify key concepts, identify where risks emerge along the agent workflow, and summarize stage-targeted mitigation strategies. Other trustworthiness aspects (value alignment, transparency, fairness, and accountability) are discussed as relevant context rather than parallel chapters. To support consistent comparison and deployment decisions, we consolidate evaluation into a unified metrics-and-benchmarks hub, emphasizing both outcome and process signals (e.g., constraint violations, trace completeness, and adversarial success rates) and offering scenario-to-metric guidance for release gating. We conclude by outlining open challenges such as self-evolving agents, runtime monitoring and verification, privacy-preserving personalization, and the trust-utility trade-off, and present a case study of real-world security failures in open-source agentic systems. Our goal is to serve as a practical reference for researchers and practitioners building trustworthy agentic systems in high-stakes environments.
Building trustworthy AI systems for mental health support is a shared priority across stakeholders from multiple disciplines. However, "trustworthy" remains loosely defined and inconsistently operationalized. AI research often focuses on technical criteria (e.g., robustness, explainability, and safety), while therapeutic practitioners emphasize therapeutic fidelity (e.g., appropriateness, empathy, and long-term user outcomes). To bridge the fragmented landscape, we propose a three-layer trust framework, covering human-oriented, AI-oriented, and interaction-oriented trust, integrating the viewpoints of key stakeholders (e.g., practitioners, researchers, regulators). Using this framework, we systematically review existing AI-driven research in mental health domain and examine evaluation practices for ``trustworthy'' ranging from automatic metrics to clinically validated approaches. We highlight critical gaps between what NLP currently measures and what real-world mental health contexts require, and outline a research agenda for building socio-technically aligned and genuinely trustworthy AI for mental health support.