Assessing Implicit Cognition Among Patients Lost to Follow-up for HIV Care: A Preliminary Study Alternate Title: Implicit Cognition and HIV Care

Eric Houston*, 1, Thomas Lyons2, Brenda Wolfe3, Norma Rolfsen4, Maryanne Williams4, Monique Rucker3, Nancy Glick3
1 Department of Psychology, Illinois Institute of Technology, Chicago, IL 60616, USA
2 College of Health Sciences, Chicago State University, Chicago, IL 60628, USA
3 Mount Sinai Hospital Medical Center, Sinai Urban Health Institute, Chicago, IL 60608, USA
4 Mercy Hospital & Medical Center, Michael Reese Research & Education Foundation, Chicago, IL 60616, USA

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© Houston et al. Licensee Bentham Open.

open-access license: This is an open access article licensed under the terms of the Creative Commons Attribution-Non-Commercial 4.0 International Public License (CC BY-NC 4.0) (, which permits unrestricted, non-commercial use, distribution and reproduction in any medium, provided the work is properly cited.

* Address correspondence to this author at Department of Psychology, Illinois Institute of Technology, 3105 S. Dearborn St., Chicago, IL 60616, USA; Tel: (312) 567-5936; Fax: (312) 567-3493; Email:



While a growing body of research indicates that implicit cognitive processes play an important role in a range of health behaviors, the assessment of these impulsive, associative mental processes among patients living with HIV has received little attention. This preliminary study explored how multidimensional scaling (MDS) could be used to assess implicit cognitive processes among patients lost to follow-up for HIV care and develop interventions to improve their engagement.


The sample consisted of 33 patients who were identified as lost to follow up for HIV care at two urban hospitals. Participants were randomly assigned to either the MDS assessment program or control group. All participants underwent measures designed to gauge behavioral change intentions and treatment motivation. Assessment group participants were interviewed to determine their reactions to the assessment program.


The MDS assessment program identified cognitive processes and their relationship to treatment-related behaviors among assessment group participants. Assessment group participants reported significantly greater behavior change intentions than those in the control group (p =.02; Cohen’s d = 0.84).


MDS shows promise as a tool to identify implicit cognitive processes related to treatment-related behaviors. Assessments based on MDS could serve as the basis for patient-centered clinical interventions designed to improve treatment adherence and HIV care engagement in general.

Keywords: Antiretroviral adherence, health behavior change, health disparities, implicit cognition, motivation, patient retention, web-based technology.