Do hard hitting adverts work?

Date: 14/02/2012 Written by: Kelly 5 minutes to read.

A hard-hitting ad is being aired as part of a campaign being run by NHS Leicester and NHS Leicestershire County and Rutland who want to show the consequences of wasting doctors time if you turn up with minor health issues such as scratches and sprains. However, according to the Daily Mail, the advert has been criticised by parents who describe the advert as ‘gratuitous’ and ‘sick’.  So, with all the hype usually generated when a new ad campaign launches we ask: do hard hitting ads work?

An advert showing a young girl dying on a hospital trolley is to be aired five nights a week on ITV in the East Midlands this month in a bid to reduce the number of people who turn up to A&E with minor complaints.

It appears that some people don’t like this advert. It shows a number of people in the accident and emergency (A&E) department who should have gone to another NHS service – such as a young man with a sprained wrist who could have seen a GP. A young girl on a hospital trolley is then pushed through the department and the girl’s voiceover says: ‘If these people think they are more important than me,‘ before her words are drowned out by a flat lining heart monitor. It is hard hitting and it sent a chill down my spine but the reality is that some people are turning up to A&E with issues that could be dealt with by the GP, pharmacy or the minor injuries clinic. So maybe we need this kind of campaign to help us walk in a different direction. Or maybe we need to now ask why people continue to turn up to A&E despite a plethora of community services.

After four years of reoccurring messages from our local hospitals and primary care trusts who keep attempting to ‘signpost’ us to the right services through numerous leaflets through the door and articles in the local paper we just keep turning up to good old A&E. So maybe we need this kind of campaign to help us walk in a different direction. Or maybe we need to now ask why people continue to pitch up despite a plethora of community services.


There is always a lot of debate and opinion about ‘shock tactics’ and hard hitting ad campaigns. This is a good thing. The debate itself raises the issue in the public mind. Whether you like them or not, the question is do they work? It will be some time before we find out if this advert has made a difference but before we attempt to answer this, take a moment to recall a public information ad – not a well known brand trying to sell you something – but an advert put out by the government or a charity. Ask yourself why you remembered this ad and write a comment at the bottom. The majority of people in focus groups we have conducted have recalled an advert because it was either funny or shocking. But overwhelmingly they recalled a particular advert because it was relevant to them - ‘it spoke to me’.

There is recipe for success and the ingredients are not rare. You need insight, a mixture of resources and the bravery of a soldier at war.

So our answer is sometimes. Shock tactics and hard hitting campaigns can sometimes work. There is recipe for success and the ingredients are not rare. You need insight, a mixture of resources and the bravery of a soldier at war. The only reason an ad ‘spoke to’ the audience was because of audience understanding and insight. The only reason it will work is because it is backed up by resources. And finally, it has only gone out because the people behind it were brave enough to take on the critics. NHS Leicester and NHS Leicestershire and Rutland are brave. They knew this ad would be controversial but they felt it was necessary. Clearly the more ‘toned down’ messages were not working.

Research studies from across the world give mixed conclusions on the effectiveness of hard hitting campaigns. Some work and some don’t. Our review of the evidence and our own research working on anti-smoking campaigns and teenage pregnancy tips in favour of hard hitting messages with some segment groups. But only when the information is clear, relevant and to the point.

It is our view that some hard hitting campaigns fail because they don’t follow through on actionable messages and resources. Yes, smoking kills, yes obesity is a problem, yes A&E is in high demand. You have caught my attention, but what can I do? How do I change? Highlighting a risk or a consequence in an ad campaign without a call to action or highlighting steps to take can lead to negative behaviour or denial. One campaign that didn’t work….

A recent study published in the BMJ that investigated the impact of adverts showing the serious harm of smoking found that ads with graphic imagery performed consistently highly. Two of these ads showed diseased human tissue or body parts, and a third used a disgust-provoking metaphor to demonstrate tar accumulation in smokers’ lungs. A personal testimonial ad performed more variably, as many smokers did not appreciate that the featured woman’s lung cancer was due to smoking or that her altered physical appearance was due to chemotherapy. An ad using a visual metaphor for lung disease was also more variable, mostly due to lack of understanding of the term ‘emphysema’. This study concluded that the ads that graphically communicate the serious harms of tobacco use are likely to be more effective and ads with complex medical terms or metaphors, or those that feature personal testimonials, are more variable and require more careful pre-testing and adaptation to maximise their potential.

One campaign that worked despite hundreds of complaints to the Advertising Standards Board in Scotland was ‘Kill Jill” a hard hitting TV campaign to drive organ donation. The ad featured a picture of a young girl’s head with a voiceover and text asking: “would you allow your organs to save a life? you have 20 seconds to decide”. The girls face slowly becomes faded and distorted with the voiceover and text appears stating “Kill Jill? yes or no? It worked. 108,000 people signed up to the register.

There is no doubt that hard hitting campaigns cut through the noise. We are bombarded with messages every day so campaigns that stand out and catch our attention are often necessary. But they must always have a behavior change message in mind. Campaigns that speak directly and honestly must be done right.  Once the audience understands that the campaign is “talking to them,” those behind it must then optimise resources and information to provide tips, guidance, and tools to motivate and empower people to take action. Simply stating a problem without a solution or way forward will just not work. Campaigns might start with a hard hitting ad, but it must not end with one.

You might also like

Get the latest insights and other interesting changemaker stuff in your inbox.

Once or twice a month, 100% real and interesting, 0% spam.
We create meaningful digital products that connect with people and make positive change possible.

Home of the changemakers.

We just need a bit more info

* indicates required

Marketing Permissions

Social Change will use the information you provide on this form to be in touch with you and to provide updates and marketing. Please let us know all the ways you would like to hear from us:

Marketing preferences

You can change your mind at any time by clicking the unsubscribe link in the footer of any email you receive from us, or by contacting us at We will treat your information with respect. For more information about our privacy practices please visit our website. By clicking below, you agree that we may process your information in accordance with these terms.

We use Mailchimp as our marketing platform. By clicking below to subscribe, you acknowledge that your information will be transferred to Mailchimp for processing. Learn more about Mailchimp's privacy practices here.

Project Planner