The quick transition of the healthcare industry to digital during the era of the Internet of Medical Things and Artificial Intelligence has ignited the demand for frameworks for data sharing while retaining safety and patient privacy. Centralized learning models place potentially sensitive patient data at risk of leakage, regulatory violation, and cyber-attacks which undermine receptivity and responsible ownership of big medical data. Federated learning is a novel paradigm that allows patients from various healthcare entities to train machine learning models while maintaining the ability to leverage their data without sharing their direct data. This study proposes a systematic literature review of approaches of privacy-preserving federated learning frameworks in healthcare applications. Following PRISMA guidelines, searches were conducted across Web of Science, Scopus, IEEE Xplore, ScienceDirect, PubMed, and ACM Digital Library with predefined query strings, explicit inclusion/exclusion criteria, and quality appraisal procedures. A total of 80 peer-reviewed studies, published from January 2015 to December 2025, were included in this systematic review, which examined cryptographic, architectural and algorithmic methods including differential privacy, homomorphic encryption, and Secure Multi-Party Computation, along with integrations using blockchain to enhance trust and confidence in distributed healthcare systems. The findings indicate a gradual shift towards hybrid privacy-preserving federated learning architectures which combined multiple security mechanisms to improve trust, confidentiality and robustness. Although significant progress has been achieved, the real-world deployment of such systems is heavily affected due to the challenges in communication efficiency, non-IID data distribution, adversarial attacks, and regulatory requirements. This research highlights future research directions for scalable, explainable and interoperable federated architectures that strike an optimal balance of privacy, utility and system performance for next-gen health intelligence. Trial registration: PROSPERO (CRD420261401073).
Alankamony et al. (Thu,) studied this question.