Personalized and Context-Aware Transformer Models for Predicting Post-Intervention Physiological Responses from Wearable Sensor Data

Personalization in wearable-based stress detection remains challenging due to substantial inter-individual variability in physiological and behavioral responses. While traditional approaches rely on user-specific fine-tuning or costly self-supervised pre-training on large datasets, we propose a lightweight alternative based on retrieval-augmented personalization. Our method leverages frozen, out-of-domain foundation models to retrieve similar patterns from a target user's history and encode them into a compact personalized embedding that modulates representations extracted by a lightweight transformer network. We evaluate our approach on the WESAD stress detection dataset with N=15 users, comprising wrist-worn physiological (EDA, BVP, temperature) and activity (accelerometer) signals, and report gains of +3.92% in accuracy and +4.76% in macro F1-score over a non-personalized transformer baseline, approaching supervised fine-tuning performance without requiring any labeled user data. We further show that temporal retrieval, where only prior user samples are available, achieves performance close to full intra-user retrieval, demonstrating robustness to limited user history. Finally, we explore personalization in a cross-dataset retrieval setting, leveraging embeddings from the K-Emocon dataset to personalize representations for stress detection on the WESAD dataset.

Commercial wearable devices continuously capture rich physiological data (e.g., heart rate, respiration), opening new possibilities for monitoring health conditions, notably around stress. Despite their promise, turning raw wearable physiological data streams into visualizations that surface stress-related insights in daily activities, and that ultimately foster reflection, awareness, and better stress management, remains a significant challenge. The data are noisy and context-dependent: the same spike in heart rate can come from sprinting, a tense presentation, or laughing with friends. To address these challenges, we propose a framework that combines user annotations with wearable data to support better stress management. We introduce a web framework offering interactive visualizations that layer daily activities, stress events, and interventions onto raw physiological streams, enabling users to reflect and identify trends. In a four-week pilot with seven university graduate and undergraduate student participants who logged 269 events, our tool revealed patterns between different types of interventions and stress: social interaction reduced average heart rate by 4.35 to 5.0 beats per minute, deliberate rest reduced average Garmin stress scores by 10.03 to 13.83 points, and mindfulness activities decreased average HRV by 6.61 to 13.22 milliseconds.

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.