Mobile-First Web Access and Captioned Video in Francophone Cardiology Education: Multicountry Ecological Learning...

Mobile health (mHealth) and online video are increasingly central to cardiology education and point-of-care decision support. However, little is known about how simple design choices, such as mobile-first web layouts and captioned videos, translate into real-world practice across countries with different income levels.

This exploratory ecological study used routinely collected, cross-platform learning analytics from a francophone cardiology mHealth initiative to (1) describe how mobile web access and caption-enabled YouTube viewing varied across World Bank income groups and (2) examine whether greater reliance on mobile access was associated with poorer engagement on the website or on YouTube.

We analyzed country-level analytics from the École Numérique de Cardiologie (ENC; Saint-Denis) mobile-optimized website and its companion YouTube channel (YouTube, LLC [Google LLC]) over a two-year window (September 2023 to September 2025). Countries were grouped as high-, middle-, or low-income (World Bank, three-level classification). Country-level metrics included mobile device session share; website bounce rate; time on page; and YouTube average view duration, audience retention, and intentional views. Caption-related and demographic YouTube metrics were available only as income-group aggregates and were therefore reported descriptively as between-group contrasts; country-level inferential analyses were restricted to country-level variables. Reporting followed the STROBE (Strengthening the Reporting of Observational Studies in Epidemiology) checklist.

Thirty-four countries contributed data: 13/34 (38%) high-income, 14/34 (41%) middle-income, and 7/34 (21%) low-income. Caption-enabled watch time was 18.8% in high-income countries (HICs), compared with 38.7% in middle-income countries (MICs) and 60.9% in low-income countries (LICs), representing a caption equity gap (CEG) of 42.1% between low- and high-income settings. Median website mobile share rose with decreasing income (36.5%, 63.3%, and 81.4%, respectively; Jonckheere-Terpstra P=.01). Across income groups, higher caption-enabled watch time coincided with a higher share of intentional views. At the country level, greater reliance on mobile access was not associated with higher bounce rate or shorter time on page, and Spearman correlations between mobile share and YouTube engagement metrics were small and nonsignificant (all |ρ|≤0.28; all P≥.18).

In this multicountry, francophone, mHealth learning analytics case study, mobile web access and captioned video were used most intensively in lower-income settings, and greater reliance on mobile access was not associated with measurable penalties in basic engagement metrics. These findings support treating mobile-optimized design and systematic captioning as core, low-cost, access-supporting features for equitable digital cardiology education. They also suggest that routinely collected platform indicators can serve as practical equity-monitoring signals for global mHealth initiatives, while underscoring that engagement metrics are not direct measures of learning or behavior change.