Sexual violence (SV) is a significant public health and societal issue with profound physical, psychological, and socioeconomic consequences, which include unintended pregnancy, genital/physical injuries, chronic pelvic pain, and increased risk of sexually transmitted diseases (STDs), including HIV (1). Sexual and reproductive health services (SRHS) are key settings that provide safe and supportive care following SV, including the provision of emergency contraception, prophylaxis against hepatitis B and HIV, testing for HIV and other STDs, and offer a pathway into other support services (2).

Despite the widespread nature of SV, survivors often face barriers to accessing timely healthcare; for example, only 21% of women in the United States reported seeking immediate medical care following SV (3). In the United Kingdom, approximately 85% of SV incidents are not formally disclosed to the appropriate authorities (4), and a National Health Service survey in England found that 72% of respondents were unaware of Sexual Assault Referral Centres (SARCs), which offer forensic and medical care after SV (5). Raising awareness of available services through public-facing materials may help address these gaps and support survivors to access the care they need.

Advertising campaigns can raise awareness of specific health issues and improve uptake of services (6). Health communication campaigns have previously demonstrated success in increasing service uptake and reducing stigma in other areas of health (7–9). For example, domestic abuse support advertising campaigns in emergency departments and maternity services in five hospitals in England have improved recognition of abuse and increased disclosures (9), while mental health campaigns targeting stigma and promoting help-seeking have successfully shifted public attitudes towards seeking care (10, 11).

Previous research on sexual violence support advertising suggests that increasing the visibility of the advertisements through optimal placement and using inclusive wording and imagery that addresses rape myths can help potential service users feel more confident in identifying as candidates for care (12–16). However, the visibility and perceived relevance of SV support advertising in healthcare settings remain underexplored.

The effectiveness of health advertising is influenced by message framing and the medium of dissemination (17). Tailored language and representation of diversity can significantly affect whether viewers perceive the information as applicable to them (18). In the context of SV, socio-cultural barriers, including stigma, fear of judgment and societal stereotypes, increase the challenges to effective advertising (19). To address these barriers, public-facing materials need to be carefully worded to help individuals recognize themselves as appropriate candidates for care (20). However, few studies have explored the effectiveness of advertising for SV support, and strategies that most effectively reach and engage different population groups remain seldom evaluated¹. Awareness and engagement with health-related information can vary based on background and personal experiences; for example, younger individuals may be more engaged with available health information, possibly due to increased use of technology to access it (21). There are also concerns that certain groups, such as individuals from minority ethnic backgrounds, may have less exposure and awareness of relevant information [(21), (see text footnote 1)].

This study uses data from a population-based survey conducted in England to investigate which factors are associated with the visibility of advertisements for SV support in healthcare settings and whether advertisements are perceived as relevant by different population groups. Such findings can be used to inform the design of future advertising campaigns directed at those who have experienced SV.

We identified several factors associated with the visibility and relevance of advertisements for support following SV. Notably, only around half of respondents in this study reported seeing SV support service advertisements in healthcare settings, indicating limited use of advertisements and/or their visibility. This aligns with findings from the National Health Service survey in England that showed 72% of the public are unaware of Sexual Assault Referral Centres (5), reflecting broader challenges in public awareness of available SV support services.

Significant differences were identified in the visibility and perceived relevance of advertising resources between different population groups, highlighting a need for more targeted and inclusive advertising strategies to address disparities and ensure equitable access to care. Existing health inequalities with regard to access to care affect some groups more than others, and advertising strategies should ensure they are reaching intended audiences (25).

Ethnic differences were evident, with White participants being significantly more likely to report seeing SV support information than individuals from other ethnic backgrounds. This is consistent with previous research indicating that minority ethnic groups often face barriers in accessing health information, possibly because of language difficulties, cultural stigma, and/or stereotyping (26). These disparities raise potential concerns about the appropriateness of SV support advertisements for minoritized groups and highlight a need to ensure advertisements are culturally sensitive and inclusive.

Younger individuals were also more likely to report seeing SV support advertisements and perceive them as relevant than older age groups. This aligns with findings from previous studies, in which younger populations tend to engage more with sexual health-related information and services (21). It may also reflect differences in sexual health engagement patterns and digital literacy among younger age groups. Current advertising strategies may be more effective in reaching younger populations, potentially due to differences in placement, design, or accessibility of these resources.

Individuals in intimate relationships were more likely to see and find advertisements relevant, possibly due to a heightened awareness of relationship dynamics that prompt engagement with services. Similarly, the perceived relevance of the advertisements among those with a history of SV may reflect greater awareness and underscore the importance of advertising in engaging with SV survivors. Prior research has shown that survivors of SV are more likely to seek and engage with support services when available information is perceived as being confidential and relevant to their background (20).

The study included a relatively large sample size, with participant demographics broadly comparable to national census data for ethnicity, disability, and sexual orientation, with the use of quota sampling (27). However, the sample may be biased toward individuals with access to and proficiency in using technology, potentially overrepresenting higher than average socioeconomic groups (28). Additionally, the survey focused on advertising in healthcare settings, excluding community and online advertising. It was also not possible to assess how effective advertisements were in facilitating attendance at services. Given the self-reported nature of the data, there is a possibility of recall bias, particularly in participants' ability to accurately remember exposure to advertising materials in healthcare settings. However, piloting of the survey instrument aimed to minimize this by ensuring that questions were clearly worded, consistently understood, and capable of capturing relevant past experiences (29).

The study findings emphasize the need for a more inclusive approach to designing and disseminating SV support services advertisements. Adopting a service user-informed co-design approach and tailoring advertisements to ensure greater visibility and relevance among underrepresented populations is likely to enhance their effectiveness. This study did not assess the effect of specific design features, content, or formats of advertisements and how this impacts visibility and acceptance, which limits the ability to determine which characteristics drive visibility and relevance across population groups. Prior research in healthcare and SV advertising has shown that design elements such as message framing, visual appeal, tone, and the use of inclusive imagery can significantly influence how audiences interpret and engage with health messaging (12–18).

Future research should build on this by examining how specific design and content features of advertisements influence engagement, particularly among underrepresented populations. This includes evaluating how elements such as tone, message framing, imagery, and delivery channels affect comprehension, relevance, and acceptance. Such work would provide comprehensive insight into not just who sees and values advertisements, but also why certain advertisements resonate with individuals. Exploring these dimensions will be essential for developing advertising campaigns that are both equitable and impactful in reaching those affected by SV.