There’s been a lot of consternation in the world of digital marketing regarding the imminent impact of Apple’s iOS 14 ATT (App Tracking Transparency) update. For those of us who specialize in patient recruitment – as well as any business who relies on generating leads and sales through targeting people online – two of the main areas that will be affected are those of audience building and retargeting. Using Facebook Lead Ads could help to circumvent the problems that will be caused in these two areas – which I’ll outline below.

Firstly, let’s have a look at what’s happening with the ATT update and what the effects will be for Facebook Ads.

Apple’s iOS 14 ATT Update

Apple announced in early 2021 that it would be updating its latest operating system – iOS 14 – with what it calls its ATT policy. ATT stands for App Tracking Transparency and essentially means that when anyone visits a website or opens an app using their Apple device, they will be presented with a popup window that asks them to choose whether to allow a record of them visiting to be tracked by another website/app or not. (Tracking in this instance being for advertising purposes, such as determining that a website visitor has visited a particular website, then showing them relevant adverts on eg Facebook).

Despite the best efforts of those of us in marketing over the years, it’s highly likely that the majority of people will choose the option to not be tracked. Which means they will not be able to be included in an audience of people with specific Interests, in the way that they would be previously. Nor will they be able to be included in an audience of people who visited our own website. Both of which make it more difficult for us to target or retarget them with our Facebook Ads.

The crux of the issue is that – where Facebook used to be able to store data about website visitors using the Facebook Pixel, then target or retarget them with adverts when those people were logged in to Facebook, the ATT prompt will now lead to a large number of people opting out of this functionality.

You might think that it isn’t going to have all that much of an effect, based on the fact your website traffic might be predominantly made up of people on desktop devices or mobile devices powered by Android, rather than Apple’s iOS 14. However, the industry is very much heading in the direction of increased levels of data privacy anyway. (For instance, with Google announcing that Chrome will no longer support 3rd party cookies from sometime in 2022).

Plus, Facebook has already implemented a confusing and somewhat unsatisfactory update to its advertising system, in order to try and counteract the effects of increased data privacy. Which means your ads will be affected even if you don’t have many iOS 14 users.

All of which brings me to an already-existing function within Facebook Advertising that doesn’t fall foul of those data privacy issues and will be unaffected by such things as the iOS 14 ATT prompt or forthcoming 3rd party cookie deprecation.

Enter Facebook Lead Ads

Here’s why Facebook Lead Ads should be valuable for audience building and retargeting in the post iOS 14 world:

– They operate purely within the confines of Facebook itself.

Anyone who uses Facebook has already signed-up to a privacy policy that entitles Facebook to show ads to them. (Whether unwittingly or otherwise). Which means that even if you are logged in to Facebook using an iOS 14 device, then, the ATT policy does not apply to this type of ad.

– People don’t know they’re going to be presented with a Lead Form when they click the Call To Action button.

The most common – and usually most effective – CTA button on a Facebook Ad is ‘Learn More’. When people click this, they might expect to be taken to a website. But, in the case of a Lead Ad, they will actually click through to the next page of the ad – the Form. Which means that, for your audience, the experience of seeing and clicking the ad is initially the same as it would be for a standard ‘click to website’ ad.

– Custom Audiences can be built from people who Open and/or Submit the Form.

Facebook defines a Custom Audience made up of people who engaged with your Lead Ad Forms as being a type of Engagement Audience. This type of audience does not rely on data from the Pixel, as all the engagement takes place within Facebook.

You can setup a Custom Audience that is made up of people who have clicked your CTA button (eg ‘Learn More’) and thus Opened the Form. This audience will be the equivalent of an audience of people who had clicked through to your website from an ad and be classed as a visitor by the Facebook Pixel on your website. People who Submit the Form can make up a further audience of ‘qualified leads’ – ie the same as people who would have filled in a form on your website.

You can then retarget ads to either or both of these audiences – in the same way you would retarget to an audience of people who had visited your website. You can also create a Lookalike audience of people who ‘look like’ the people in these audiences – in the same way you would create a Lookalike audience of website visitors or qualified leads.

– Form fields can be pre-filled, so it’s no big effort for people to submit them.

Having the form fields pre-filled with contact data makes it very easy for people to submit them, so you are potentially more likely to receive email addresses through Lead Ads than you would through a website form.

– Building a list based on email addresses is unaffected by iOS 14 or 3rd party cookies.

With a list of email addresses that you collect through the form, you have another means of creating an audience within Facebook. Again, you would be able to use this audience for the creation of Lookalikes and for Retargeting.

Downsides of Using Lead Ads

One of the downsides of relying on Lead Ads for patient recruitment is you are not allowed to ask specific health-related questions on a Lead Form. Which means you can’t incorporate inclusion/exclusion criteria in the way you could with a form on your website. What you can do, though, is specify who you’re looking for in the text that appears above the form, which should help to filter out people who don’t fit the relevant criteria.

Another downside to this strategy is that all the data is contained and only works within Facebook itself. You can’t, for instance, build a Custom Audience of people who Opened but Didn’t Submit the Form, then use that audience to target them on Google or LinkedIn – you can only target them on Facebook.

However, my experience of patient recruitment for clinical trials has shown me that Facebook is by far the most effective platform for generating patient leads, so you’ll be able to reach the vast majority of your potential audience through Facebook anyway. If that situation changes, I’ll be among the first to be recommending a different platform to advertise on. (I don’t expect Facebook’s effectiveness to significantly diminish anytime soon, but I’ll certainly be keenly interested in the effects of the forthcoming changes, so I can continue to maximise the number of patients I help recruit for trials).


If you use Facebook Advertising as part of your marketing strategy – and, for patient recruitment or other forms of lead generation, I certainly recommend that you do – Facebook Lead Ads could help reduce the potentially negative impact of the iOS 14 ATT policy change.