Trust transfer from medical AI to doctors and hospitals: Integrating digital, AI, and scientific literacy in a cross-sectional framework

This study investigates how different forms of literacy shape trust in medical AI and its transfer in healthcare contexts. Based on a survey of 1,250 participants, three findings emerge. First, digital literacy and AI literacy exert opposite influences on medical AI trust: while digital literacy enhances trust, higher AI literacy unexpectedly reduces it. This paradox highlights a theoretical puzzle in technology acceptance, suggesting that deeper knowledge can generate informed skepticism rather than blind confidence. Second, trust in medical AI transfers hierarchically, flowing to hospitals only through physician trust as a critical intermediary, underscoring the role of interpersonal trust in institutional trust building. Third, scientific literacy moderates this process, with higher literacy dampening trust transfer, reflecting the impact of cognitive processing differences. These results extend theories of trust and technology acceptance by integrating multiple literacies and uncovering divergent cognitive pathways. Practically, they call for communication strategies and policy designs that calibrate trust-strengthening physicians' role as trust brokers, balancing education about AI's capacities and risks, and leveraging explainable AI tools to sustain appropriate confidence in medical AI.