Brand equity has always been a fuzzy concept. Companies spend millions tracking awareness, measuring brand lift, running NPS surveys — and still struggle to connect any of it to revenue. A study published in Harvard Business Review this spring makes that connection explicit. The numbers are specific. And they change the math on how brand signals should be managed.
The research, conducted with CVS Health and published in April 2026, surveyed more than 9,000 shoppers across CVS Pharmacy and several competitors — including Amazon, Walmart, and supermarket pharmacies. Participants answered open-ended questions about what comes to mind when they think about these brands. Researchers also tracked how much those customers spent in the months that followed. The core finding: the number of associations a customer holds about a brand directly predicts their future spending. Each additional positive association — things like “friendly staff” or “convenient locations” — correlated with an 18% increase in spending. Each additional negative association correlated with a 12% decline.
These aren’t impressions. They’re revenue.
What You’ll Learn
- What brand associations are and why they differ from what most tracking surveys actually measure
- The specific spending impact of positive and negative associations from the CVS Health research
- Why some associations are worth five times more than others
- How negative associations do compounding damage over time
- What this research implies for how brand signals should be managed
What Are Brand Associations, and Why Do They Differ from Standard Brand Tracking?
Brand associations are the thoughts that surface spontaneously when someone encounters your brand. They’re captured through open-ended questions — “What comes to mind when you think of Brand X?” — not through agree/disagree rating scales. That distinction matters more than it sounds.
In previous smartphone brand research, the same team compared open-ended association data to standard rating-scale data. When they relied on rating scales, the correlation with market share “largely disappeared,” according to the HBR article. The spontaneous associations still correlated strongly. What customers organically think of when they encounter your brand carries different predictive weight than what they agree with when prompted.
The research team calls this “authentic brand associations” — language consumers use naturally, without prompting. These associations can be positive, negative, or neutral. They shift as customers accumulate more interactions with the brand. And because they’re captured through open-ended responses, they typically surface dozens or even hundreds of distinct themes — far more than traditional brand tracking captures.
Kevin Lane Keller’s foundational 1993 work on customer-based brand equity framed brand knowledge as an associative memory network: a web of nodes, where the brand sits at the center and associations are the connections. The more connections that exist, the more easily the brand gets retrieved from memory. The more it gets retrieved, the more likely it gets chosen. The CVS Health research takes that framework and attaches revenue numbers to it.
As a general rule, what customers spontaneously think about your brand predicts future behavior more reliably than how they respond to prompted questions about it.
What Did the Research Actually Find?
Each additional positive association a customer holds correlates with an 18% increase in their spending. Each additional negative association correlates with a 12% decrease. These effects are cumulative — they add up across the total number of associations a customer holds, in both directions simultaneously.
The study tracked not just spending at the time of the survey, but changes in spending over the following months. That matters. It rules out the simpler explanation that customers with positive perceptions just happen to spend more. It shows perceptions predict how behavior changes over time — which is the causal question brands actually need to answer.
The research also introduced a concept called “customer surplus value” — measuring how much compensation it would take for a customer to give up access to a brand for a month. Customers who wouldn’t give up CVS Pharmacy even for $400 spent roughly twice as much in the following months as those who would accept compensation. Customer surplus value tells you how valuable your brand is to its customers. Authentic brand associations explain why.
If you want to know how valuable your brand is to customers, measure what it would take for them to leave. If you want to know why, ask what they think of first.
Why Are Some Associations Worth Five Times More Than Others?
Not all associations carry equal economic weight. The research found that some were worth up to five times more than others in their impact on customer surplus value and spending. “Friendly/helpful service” ranked as the highest-value association in the CVS Health data — not because friendliness is universally more important than price or location, but because in a retail pharmacy context, service quality is the one thing a competitor can’t replicate by opening a nearby store.
The research coded open-ended responses using a combination of manual review and AI tools, building a taxonomy that groups related expressions into broader themes. “Busy,” “crowded,” and “long lines” describe the same operational experience but surface in different language. Each maps differently to spending depending on which brand they’re attributed to. An association that carries strong negative impact at one pharmacy may read as neutral at another — because the broader brand context is different.
This creates a diagnostic opportunity most organizations don’t use. If you know which associations correlate most strongly with spending — and which ones are most prevalent in your customer base — you can sequence what to fix and what to amplify. The association with the highest economic value isn’t always the one you’re performing best at. The one with the highest negative impact isn’t always the one you’re most actively working to address. These gaps — between where your signals land and where value is actually built — are where most brand strategy happens by default rather than by design.
The most common failure mode: optimizing for the associations where you’re most visible, rather than the associations that actually drive value. These two lists are rarely identical.
How Do Negative Associations Affect Revenue?
Negative associations don’t dilute positive ones — they actively subtract. Each negative association correlates with a 12% spending decline, and the research found that negative emotional associations like frustration and anger often had an outsized impact, varying across brands.
This asymmetry matters for how you think about brand management. A brand that earns three new positive associations and one new negative association doesn’t net out at “+2 with a little drag.” The negative is working against the positives simultaneously, not sequentially. Three positive associations produce roughly +54% spending lift potential. One negative costs -12% off baseline spending. The negative still costs real money regardless of how many positives surround it.
Consider what this implies at scale. Every interaction that produces a spontaneous negative association — a bad service experience, a product that didn’t deliver, a communication that felt off — has a measurable revenue consequence, not just a reputational one. And because associations accumulate over time, they compound. A customer who has associated “long wait times” with a brand for three years has that association embedded deeply in their mental network. It takes more positive signal to displace it than it would have taken to prevent it.
Negative associations don’t stay isolated. In an associative memory network, a strongly negative node activates adjacent ones. One bad experience can make other memories read more negatively by proximity — which means the revenue consequence of a single painful interaction is wider than it first appears.
What Does This Research Mean for Brand Management?
Managing brand associations isn’t a communications function — it’s an operations, product, and service function that happens to have communications consequences. “Friendly/helpful service,” the highest-value association in the CVS research, isn’t produced by better marketing. It’s produced by how staff are hired, trained, and managed. That’s a different lever, requiring different decisions.
This is what makes the research useful and uncomfortable at the same time. It tells you that brand perceptions are economically meaningful. It doesn’t tell you the solution is a campaign. The associations customers hold are produced by every interaction they have with your organization — not just the ones you designed intentionally.
A brand that generates strong positive associations across multiple dimensions is doing something structural. It’s not winning on any single touchpoint; it’s compounding wins across many. Each positive association makes the brand easier to recall, more likely to be chosen, and more resilient when something goes wrong. That resilience has economic value: brands with dense positive association networks lose customers more slowly after a negative experience, because the negative has to compete with more existing positive signal before it changes behavior.
CVS Pharmacy has since incorporated brand density and customer surplus value tracking into its standard brand monitoring — not as a campaign metric, but as an operational metric, used to identify where service improvements would have the highest revenue impact.
Treat brand associations as leading indicators of revenue, not lagging indicators of sentiment. They tell you what’s about to happen to your numbers before your numbers reflect it.
Conclusion
Brand associations are revenue. Every signal your brand sends — every interaction, every experience, every communication — either adds to or subtracts from the mental network customers hold about you. The CVS Health research puts hard numbers on a mechanism that most practitioners have assumed but couldn’t quantify.
The common pitfall is treating this as a measurement problem. Tracking associations is valuable. But the associations themselves are produced upstream — in how your product works, how your service behaves, how your organization operates at every touchpoint. The tracking tells you what’s happening. The signal goes back to operations, service design, and culture.
The work compounds, or it doesn’t.
