Ethical AI innovation in healthcare and sustainable development in Bangladesh

This study examines how artificial intelligence (AI) innovation and ethical governance influence sustainable healthcare outcomes in Bangladesh, with patient trust and perceived safety acting as mediators and digital and health literacy serving as moderating conditions.

A qualitative research design was employed, using semi-structured interviews with five purposively selected stakeholders representing policy, technical, managerial and community health perspectives. Data were analyzed thematically following Braun and Clarke's six-phase approach, using a hybrid deductive-inductive coding strategy supported by NVivo 14. A dual-stage literature review (comprehensive and integrative) informed the conceptual moderated-mediation framework grounded in ethical governance theory, digital transformation theory and the trust-based model of patient engagement.

The findings reveal that AI innovation enhances diagnostic accuracy, efficiency and personalization, while ethical governance -through fairness audits, transparency protocols and accountability measures - builds user confidence and inclusivity. Patient trust and perceived safety emerged as pivotal mechanisms translating technical and ethical design into engagement and adherence. Digital and health literacy significantly moderated these relationships, with low literacy limiting accessibility and equitable impact and targeted literacy interventions enhancing trust and participation.

The study recommends embedding ethics-by-design principles, culturally adapted interpretability features, and literacy-focused engagement strategies into AI healthcare systems. Policymakers should establish unified ethical AI frameworks, strengthen regulatory enforcement and integrate AI ethics into national health literacy and workforce development initiatives.

This research offers one of the first empirically grounded moderated-mediation models linking AI innovation, ethical governance, patient trust and literacy to sustainable healthcare outcomes in a low-resource, Muslim-majority context. It advances theory by integrating ethical governance and digital transformation perspectives with behavioral trust models, and provides actionable insights for inclusive and context-sensitive AI adoption in healthcare systems of emerging economies.