Unequal Interactions

Examining the Role of Patient-Centered Care in the Inequitable Diffusion of a Medical Innovation, the Human Papillomavirus (HPV) Vaccine

Published in: Social Science & Medicine [Epub October 2017]. doi: 10.1016/j.socscimed.2017.09.030

by Anny Fenton, Marc N. Elliott, David C. Schwebel, Zahava Berkowitz, Nicole C. Liddon, Susan R. Tortolero, Paula Cuccaro, Susan L. Davies, Mark A. Schuster

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Research Question

  1. What are the associations among providers' HPV vaccine recommendations, patient-centered care (PCC), HPV vaccination, and race/ethnicity?


Studies of inequities in diffusion of medical innovations rarely consider the role of patient-centered care.


We used uptake of the human papillomavirus (HPV) vaccine shortly after its licensing to explore patient-centered care's role.


Using a longitudinal multi-site survey of US parents and adolescents, we assessed whether patient-centered care ratings might shape racial/ethnic and socioeconomic gaps at two decision points in the HPV vaccination process: (1) Whether a medical provider recommends the vaccine and (2) whether a parent decides to vaccinate.


We did not find evidence that patient centeredness's associations with vaccination vary by parent education. In contrast, parent ratings of provider's patient-centeredness were significantly associated with racial/ethnic disparities in parents' reports of receiving a HPV vaccine recommendation from a provider: Among parents who rate patient-centered care as low, white parents' odds of receiving a such a recommendation are 2.6 times higher than black parents' odds, but the racial/ethnic gap nearly disappears when parents report high patient-centeredness. Moderated mediation analyses suggest that patient-centeredness is a major contributor underlying vaccination uptake disparities: Among parents who report low patient-centeredness, white parents' odds of vaccinating their child are 8.1 times higher than black parents' odds, while both groups are equally likely to vaccinate when patient-centeredness is high.


The results indicate that patient-centered care, which has been a relatively understudied factor in medical innovations' unequal diffusion, deserves more attention. Efforts to raise HPV vaccination rates should explore why certain patient groups may be less likely to receive recommendations and should support providers to consistently inform all patient groups about vaccination.

Key Findings

  • Racial/ethnic minority parents who reported low PCC were less likely than white parents to receive an HPV vaccination recommendation.
  • When PCC was low, the odds of vaccination differed more by race and ethnicity.
  • This study confirmed previous findings of a strong association between recommendation to vaccinate and parents' vaccination decision.
  • These findings suggested that black children are significantly less likely to receive vaccination if their parent does not receive a provider's recommendation to vaccinate.
  • PCC was associated with more vaccine recommendations for all parents' educational level.


  • Physicians may be able to use PCC and vaccine recommendations to increase HPV vaccination and reduce racial and ethnic disparities in HPV vaccination.
  • Future research should investigate how clinicians decide to recommend medical innovations, such as HPV vaccination, and whether such decisions vary based on the patients' race or ethnicity.

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