JMIR Publications

ABSTRACT

Background:

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 video—function as equity enablers across income settings when examined with multi-country learning analytics.

Objective:

This exploratory ecological study used real-world, cross-platform learning analytics from a French-language cardiology mHealth education initiative to quantify how mobile web access and captioned YouTube viewing varied across World Bank income groups and assess whether greater reliance on these access enablers was associated with poorer engagement.

Methods:

We analyzed country-level analytics from the École Numérique de Cardiologie (ENC) mobile-optimized website and companion YouTube channel over a 2-year period. Countries were grouped as high-, middle-, or low-income. Primary access indicators were the share of website sessions from mobile devices and the share of YouTube watch time with subtitles enabled (any language). Engagement outcomes included website bounce rate and time on page and YouTube average view duration, audience retention, and intentional views. We summarized medians by income group and explored associations using nonparametric tests, Spearman correlations, and median quantile regression.

Results:

Thirty-four countries contributed data (13 high-income, 14 middle-income, 7 low-income). Caption-enabled watch time showed a marked income gradient, increasing from 18.8% in high-income to 38.7% in middle-income and 60.9% in low-income groups, a caption equity gap of 42.1 percentage points between low- and high-income settings. Median mobile share of website sessions also rose with decreasing income (36.5%, 63.3%, and 81.4%, respectively). Income groups with higher caption use also had a higher share of intentional views and younger audiences. Greater reliance on mobile access was not independently associated with higher bounce rate or shorter time on page in quantile regression models.

Conclusions:

In this multi-country mHealth learning analytics case study, mobile-first web access and captioned video were used most intensively in lower-income settings and were not associated with penalties in basic engagement metrics. These findings support treating mobile-optimized design and systematic captioning, including non-French subtitles, as core, low-cost components of equitable digital cardiology and mHealth education, and suggest that simple analytics indicators can serve as equity-focused monitoring tools for global mHealth initiatives.