FLAG: Fatty Liver Awareness Game for Liver Health Literacy in Last-Semester Software Engineering Students

Non-alcoholic fatty liver disease affects approximately thirty percent of the global population, yet public awareness remains dangerously low among young adults facing occupational risk factors. This study introduces the Fatty Liver Awareness Game (FLAG), an educational serious game designed to improve liver health literacy among software engineering students at the University of Guayaquil. While evaluated with this specific sample, FLAG is intended for the broader target population of young adults in developing nations who face occupational sedentary risk and limited access to preventive health education. Through a controlled experiment with fifty participants randomly assigned to game-based or traditional lecture instruction, the game demonstrated superior effectiveness, with a twenty-percentage-point advantage in post-test scores and a seventy-two percent reduction in incorrect responses compared to fifty percent in the lecture group. The large effect size (Cohen’s d = 1.43) and reduced performance variability among game participants indicate that interactive, feedback-rich learning environments can outperform passive instruction for this population and content domain. While the present design does not isolate the contribution of individual game elements—such as narrative framing, explanatory feedback, or mini-game interleaving—the results establish FLAG as a replicable model for digital health interventions targeting underserved populations at critical developmental junctures. Future component analyses are needed to determine which specific design features drive the observed advantages.