Refugee-centered framework for design of digital health interventions: a qualitative study with Ukrainian refugee women in Norway.

Introduction: Ukrainian refugee women face multiple barriers when accessing healthcare systems in host countries, including language challenges, differences in healthcare system structures, prior experiences, and issues of trust and expectations. Digital health interventions have been increasingly used to support access to health information and services for refugee populations. However, evidence remains limited regarding how refugee women understand, navigate, and engage with digital health within host country healthcare systems. This study aims to identify the needs and expectations of Ukrainian refugee women in relation to digital health and healthcare navigation in Norway, and to develop a refugee-centered, empirically grounded framework to inform the design of digital health interventions that support equitable healthcare access. Methods: A qualitative design was employed, including five age-segmented focus group discussions with thirty Ukrainian refugee women aged 18-24, 25-54, and 55+ years. Participants also completed a pre-study questionnaire documenting demographic characteristics and prior use of digital health. Data were analyzed thematically and subsequently interpreted through a user experience framework as an analytical lens. Results: Nine overarching themes were identified, describing navigation challenges shaped by prior system experiences, age-related differences in information use, prevention priorities, trust, language accessibility, the need for step-by-step guidance, information structure and usability, digital overload, and the cautious use of artificial intelligence and digital contact tools. Discussion: These findings were further synthesized into user-centered design requirements for digital health interventions. Based on these findings, a refugee-centered framework is proposed for designing digital health interventions. The framework identifies six core components: navigation and pathway guidance, age-responsive design, trust and verification, language and cultural adaptation, artificial intelligence-supported features, and cognitive ease, accessibility, and universal design. Conclusions: This study contributes to more equitable and user-centered digital health design by translating the lived experiences of Ukrainian refugee women into actionable design principles that support navigable, trustworthy, and linguistically accessible healthcare systems.