Explainable AI Using Inherently Interpretable Components for Wearable-based Health Monitoring

Wearable sensors continuously capture fine-grained multivariate time-series data, providing opportunities to model behavioural patterns associated with health outcomes. However, existing deep learning methods prioritise predictive accuracy over interpretability, limiting their application in health research. In this study, we present HealthCAT, a flexible framework that integrates an Encoder-only Transformer with an Attentive Class Activation Token (AttentiveCAT) to generate class-specific, time-step-level interpretations. These interpretations can be mapped back onto behavioural cycles that are relevant to the domain (e.g., time-of-day), supporting individual-level analysis of wearable sensor data. We evaluated HealthCAT using two real-world wearable sensor datasets (306 participants in total). HealthCAT outperformed deep learning baselines by up to 17% in F1-score and 12% in accuracy on both datasets ($p<0.05$). In masking experiments, the time steps identified by HealthCAT carried significantly more predictive value than random selection across all masking conditions ($p<0.05$), indicating that the identified time steps are predictively informative. By coupling predictive performance with validated time-step-level interpretability, HealthCAT moves wearable sensor analysis beyond aggregated metrics towards temporal patterns that support health monitoring, behavioural pattern analysis, and intervention design in health research. The significance of this work is that it enables accurate prediction of health indicators from wearable sensor data while providing insights into when and how physical activity patterns occur, rather than relying solely on aggregated summary measures.

Human activity recognition (HAR) has become a key component of intelligent systems for healthcare monitoring, assistive living, smart environments, and human-computer interaction. Although deep learning has substantially improved HAR performance on multivariate sensor data, the resulting models often remain opaque, limiting trust, reliability, and real-world deployment. Explainable artificial intelligence (XAI) has therefore emerged as a critical direction for making HAR systems more transparent and human-centered. This paper presents a comprehensive review of explainable HAR methods across wearable, ambient, physiological, and multimodal sensing settings. We introduce a unified perspective that separates conceptual dimensions of explainability from algorithmic explanation mechanisms, reducing ambiguities in prior surveys. Building on this distinction, we present a mechanism-centric taxonomy of XAI-HAR methods covering major explanation paradigms. The review examines how these methods address the temporal, multimodal, and semantic complexities of HAR, and summarize their interpretability objectives, explanation targets, and limitations. In addition, we discuss current evaluation practices, highlight key challenges in achieving reliable and deployable XAI-HAR, and outline directions toward trustworthy activity recognition systems that better support human understanding and decision-making.

Modern applications of AI rely on increasingly complex models. Explainable AI (XAI) has emerged as a set of techniques aimed at improving model transparency. However, existing XAI methods typically assume input features to be inherently interpretable, or they rely on intermediate internal abstractions that are difficult to characterize and highly architecture-specific, hindering consistent use across models. To address these limitations, we propose DictXAI, a method that defines concepts directly in the input domain via a dictionary---a large, potentially overcomplete set of predefined elements, each carrying an interpretable meaning. Technically, DictXAI first computes a sparse code of the input and then attributes the model's prediction to the associated dictionary elements. We demonstrate the actionable nature of DictXAI explanations, showing that they can attribute AI malfunctions (e.g., Clever Hans effects) directly to identifiable artifact patterns in the data, while fostering human-AI alignment on intricate biomedical signals. We further demonstrate our method's ability to operate across a wide variety of dictionaries, including learned image bases, analytically defined waveforms for electrocardiography, and experimentally acquired dictionary elements. Overall, our results show that DictXAI provides more interpretable, actionable, and architecture-agnostic insights than classical XAI or existing concept-based approaches.