Governing Trust in Health AI: A Qualitative Study of Cybersecurity Professionals’ Perspectives

Abstract

Abstract Background Artificial intelligence is increasingly embedded in healthcare delivery. Its legitimacy depends on institutional governance, not technical performance alone. Prior research has centered on clinicians and patients. Less attention has been given to cybersecurity professionals who sustain the digital infrastructures that support health AI. This study examines how cybersecurity professionals conceptualize AI as clinical infrastructure and how these interpretations shape understandings of trust, risk, and oversight. Methods Guided by sociotechnical systems theory and institutional trust scholarship, we conducted semi-structured in-depth interviews with twenty cybersecurity professionals working in healthcare-relevant domains. Participants were recruited through professional networks and LinkedIn outreach. Interviews were conducted between May and August 2025. They were audio-recorded and transcribed verbatim. Data were analyzed using qualitative content analysis with constant comparison. Two researchers independently coded transcripts and refined themes through iterative discussion. The study received Institutional Review Board approval. Results Participants described health AI as an augmented clinical infrastructure. They emphasized that AI extends workflow capacity but requires sustained human oversight. Healthcare data systems were characterized as fragmented and vulnerable. Breaches were treated as anticipated events. Trust in AI was described as contingent and built over time through visible accountability. Cybersecurity stewardship was framed as foundational to institutional trustworthiness. Conclusions Health AI credibility emerges through governance practices that demonstrate accountability. Cybersecurity professionals and institutional stakeholders jointly shape trust in digitally mediated healthcare systems through governance decisions that signal accountability.

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