What’s Ugly? — And Other Crucial Conversations for Nurses

By Shawn Kennedy, AJN editor-in-chief

Metal billboard, Bubaque, Guinea-Bissau, 2010. Photo by Dawn Starin.

Our monthly Art of Nursing department—often, a poem or image somehow related to health care—is a unique feature for a scholarly publication, but one we feel strongly about. We believe that in order to provide truly holistic care, nurses need to know about more than evidence-based clinical content—they also need to be aware of many other aspects of the human experience. 

One thing art teaches us is that people don’t always see things the same way. What’s beautiful, illuminating, or at least useful to one person may be ugly or offensive to another. Consider billboards with public health messages. To some, such a billboard may seem to be an eyesore blotting the landscape; to others, the image and message is a powerful tool for disseminating life-saving information. Our September 2010 Art of Nursing (click through to the PDF version) showcased billboards in Guinea-Bissau, a poor country with HIV prevalence  of epidemic proportions. The billboards, photographed by Dawn Starin (here’s a blog post she wrote about them), are used to encourage people to get tested. A blog post by AJN senior editor Sylvia Foley about the column noted concerns some had expressed about these billboards:

Are the billboards effective? Starin writes, “Although the billboards are fabulous to look at, many health professionals I spoke with thought they exemplified time and money wasted, in part because of the high nationwide illiteracy rate.” One health worker emphasized the need for more culture-specific studies on sexual practices and tradition, so that appropriate education programs could be developed.

On the other hand, here’s an excerpt from a recent comment by one reader of Sylvia’s blog post:

I think using public health billboards in Guinea-Bissau to combat the epidemic of HIV-AIDS is a great tool to reach out to the community and create awareness. Creative billboards do in fact attract people’s attention especially when it’s something as important as getting tested for HIV and AIDS. I can speak from personal experience as one day I was driving down a major highway in Miami, Florida and saw a very creative billboard about getting tested. The message on the billboard stuck with me for days until I decided to get tested. These billboards may not motivate everyone to get tested but I’m sure I wasn’t the only one that this billboard inspired to get tested.

We don’t know the results of this commenter’s test results—we can only hope they were negative. But the important point is that the billboard was effective: this person got tested. 

What are some other notable billboards promoting public health messages? If you’ve seen them, send us photos of the billboards (to Shawn dot Kennedy at WoltersKluwer dot com). We’ll post them online (and credit you!) and help spread the word.

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2016-11-21T13:13:30+00:00 April 18th, 2011|Nursing|12 Comments
Senior editor/social media strategy, American Journal of Nursing, and editor of AJN Off the Charts.


  1. N. Nunez August 6, 2012 at 11:02 pm

    I feel public billboards can impact an individual to react. The message displayed in public billboards are there to provide information one may not be aware of. HIV/AIDS is a major health concern to all people on earth. Expressing messages on public billboards will hopefully get the message to all that this disease is deadly. I have noticed many health related public billboards in my area regarding the health risks of smoking. Many public billboards that I have seen about smoking display pictures of people with current cancer related health problems from smoking. Most of these public billboards create a sign of shock to me. I hope smokers can relate to the same feeling when seeing this advertisements on the streets of Miami.
    I agree that publics billboards about HIV/AIDS and smoking will help all people either get tested or stop smoking!

  2. Maria S. August 6, 2012 at 1:06 pm

    I agree with the fact that Billboards, can be an excellent communication tool all over the world. Billboards are an effective way to provide large amount of people with information in a short amount of time. They provide preventive information to help communities. However, I do recognize that not every country has the means to provide them, or their people have not the sufficient academic level to comprehend them. Still, for those people Billboards can be more about pictures that can influence them to take care of their health. As it was mentioned in the text controversies exists of whether or not they work, I personally think that for many individuals they serve its purpose.

  3. Roldine M. April 16, 2012 at 10:23 pm

    Billboard can be an effective tool of communication because it reaches thousands of people in a fraction of time. I am sure that is why now they have these billboards for the amber alerts.
    They are an effective way to educate people on health care issues especially in developed countries such as USA. I believe that most high income countries tend to have a moderate percentage of people who can actually read and comprehend at least at elementary level. For low income countries such as Haiti, billboards/signs need to be written at the same literacy level of the people living in that surrounding area. What use will they be if no one comprehends them? We also need to make sure billboards

  4. Precious Lanier April 16, 2012 at 7:30 pm

    I agree with the theory of holistic care being more than evidence based nursing practice. It is my opinion that nurse scholars need to acknowledge the time and effort that must be taken to implement these practices. Though it is important its effectiveness on day to day health issues is minute. Furthermore, I agree that nurse need to look beyond the scientific- theory of evidence based practice and include real life situations and circumstances. I believe including artwork as a healthcare approach is awesome! Art speaks all languages and reaches all cultures. For example, no words are needed to communicate a universal symbol of a breast cancer ribbon. Yet, just the display of the billboard may cause someone to get an exam completed. Whether a billboard is viewed positively or negatively it opens the door to discussion of the subject being portrayed. Whether the photo on a billboard is gross or beautiful after seeing a billboard its image is imprinted in one’s mind. If the photos are effective it may even prompt and individual to take action.

  5. Barbara F. April 16, 2012 at 10:59 am

    I believe Billboards are an excellent method of communication. They are also a powerful tool to educate the population and a way of getting information to a high proportion of people with minimal investment. I think this is remarkably effective especially in undeveloped countries where perhaps people lack access to other means of communication because of the level of poverty. I think that any tool we use is essential in educating the community. I am a big believer that repetition enforces learning. Placing a large sign where everyone will see it every time they travel around is an effective way of reinforcing or transmitting a message.

  6. Marlene April 11, 2012 at 9:40 pm

    I believe that Billboards play an important role in subconscious as well as the visual. For example, when driving down in the highway and looking at billboards, people can get interested in for instance the lottery. They would decide to play or not.
    When you see a billboard ad, the colors emote a mental feeling, wether it’s hunger or buy more or place you in a serene state. When used for awareness on a health issue for instance it also makes some people react and other people think about the problem even if it is for a little while.
    Perception also plays a role in this. Some people get emotional while others get offended by what is portraited. It is all a play of how to be in the gray area….

  7. Regina L. Curry November 21, 2011 at 6:43 pm

    The billboard is a great form of mass communication, this reach the largest number of people in the shortest amount of time. Everyone does not have access to television, radio or print news. Even if a person cannot read the board, it’s presence with the mother and her child will cause people to communicate about the picture and the words surround it. The purpose of a communication tool, is to get the message out and encourage people to talk and hopefully act. This disease has touch every segment of our society and the numbers are growing each year. I have lost a relative to HIV/AIDS, and if one person was reach, then several lives has been changed. When my uncle was tested in the 80’s people treated my family like we had the plague and started distancing themselves from us. He died knowing his status, and that knowledge prevented him from spreading it and he died with his family love.

  8. Juliette.C SRN November 21, 2011 at 3:04 pm

    Advertisements on billboards tend to be very effective when it comes to leaving a memorable impression on whoever sees them. If the message is powerful it will stick to your memory whether you want it or not regardless of if it being a picture, a word, or a combination of both. I remember driving on the expressway and seeing a billboard with the word CANCER. It had no pictures or any sort of embellishment, in fact it was quite plain, but it stuck to me for quite a while. Such a simple word in a plain, white billboard made me think about its meaning and everything it implied.

  9. C Garst August 8, 2011 at 6:42 pm

    Billboards are important public health tools to transfer information, concepts, and ideas to both general and specific audiences. The uses of outdoor media like billboards are important vehicles to reach public health goals particularly in developing countries. For example, Uganda has implemented a successful HIV prevention campaign by promoting ways to prevent this disease in billboards around the country. Uganda used folk beliefs and culturally appropriate language during the HIV campaign. In contrast, in other developing countries the use of billboards use for a public health campaign is not very effective, because it did not use the folk culture of the area to increase the audiences belief and trust in health education.

  10. christina johnson April 18, 2011 at 8:12 pm

    I do agree that the use of billboards can be an effective way of advertising to persuade the viewing audience to act or feel a certain way. One such campaign comes to mind. It was initiated to address the AIDS crisis in South Africa and was called loveLife. The idea was to change the attitudes young people had regarding sex by getting them to talk about it more and getting away from the scare tactics previous ads used. The idea was to make them more cheerful, bright and persuasive like the more modern ads. An example of one of the billboards showed the hands of four women of different races carressing the buttocks of a young black well sculptured man. The caption below read, ” Everyone he’s slept with , is sleeping with you.” This type of advertising is meant to get young people talking about sex in responsible ways. More information on loveLife can be found in the book Emerging Contemporary readings for Writers by Barclay Barrios.

  11. Debra Lewis April 18, 2011 at 6:41 pm

    I agree, as a high income country and world leader, the United States (US) should shift or focus more one preventive care and identifying and getting the information to those groups of people that are high risk. The billboards are great at getting someones attention as long as it is at basic literacy level with pictures and colors. Just a thought, those same billboards can be distracting because someone will attempt to read while driving! Very dangerous. That’s where pamphlets, radio and television also comes into play as well as getting celebrity endorsements.

  12. Peggy April 18, 2011 at 1:16 pm

    I would love to see more billboards in the US promoting the new Speak Up campaign for patients… anything we can do to increase healthcare literacy will increase wellness and decrease overall cost to our system!

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