BackgroundMedication adherence is a global public health challenge, as only approximately 50% of people adhere to their medication regimens. Medication reminders have shown promising results in terms of promoting medication adherence. However, practical mechanisms to determine whether a medication has been taken or not, once people are reminded, remain elusive. Emerging smartwatch technology may more objectively, unobtrusively, and automatically detect medication taking than currently available methods.ObjectiveThis study aimed to examine the feasibility of detecting natural medication-taking gestures using smartwatches.MethodsA convenience sample (N=28) was recruited using the snowball sampling method.During data collection, each participant recorded at least 5 protocol-guided (scripted) medication-taking events and at least 10 natural instances of medication-taking events per day for 5 days. Using a smartwatch, the accelerometer data were recorded for each session at a sampling rate of 25 Hz. The raw recordings were scrutinized by a team member to validate the accuracy of the self-reports. The validated data were used to train an artificial neural network (ANN) to detect a medication-taking event. The training and testing data included previously recorded accelerometer data from smoking, eating, and jogging activities in addition to the medication-taking data recorded in this study. The accuracy of the model to identify medication taking was evaluated by comparing the ANN’s output with the actual output.ResultsMost (n=20, 71%) of the 28 study participants were college students and aged 20 to 56 years. Most individuals were Asian (n=12, 43%) or White (n=12, 43%), single (n=24, 86%), and right-hand dominant (n=23, 82%). In total, 2800 medication-taking gestures (n=1400, 50% natural plus n=1400, 50% scripted gestures) were used to train the network. During the testing session, 560 natural medication-taking events that were not previously presented to the ANN were used to assess the network. The accuracy, precision, and recall were calculated to confirm the performance of the network. The trained ANN exhibited an average true-positive and true-negative performance of 96.5% and 94.5%, respectively. The network exhibited <5% error in the incorrect classification of medication-taking gestures.ConclusionsSmartwatch technology may provide an accurate, nonintrusive means of monitoring complex human behaviors such as natural medication-taking gestures. Future research is warranted to evaluate the efficacy of using modern sensing devices and machine learning algorithms to monitor medication-taking behavior and improve medication adherence.