Anny T Fenton1, Marc N Elliott2, David C Schwebel3, Zahava Berkowitz4, Nicole C Liddon5, Susan R Tortolero6, Paula M Cuccaro7, Suzy L Davies8, Mark A Schuster9. 1. Department of Sociology, Harvard University, 33 Kirkland Street, Cambridge, MA 02138, USA. Electronic address: afenton@fas.harvard.edu. 2. 1776 Main Street, RAND Corporation, Santa Monica, CA 90401, USA. Electronic address: elliott@rand.org. 3. Department of Psychology, University of Alabama at Birmingham, Campbell Hall 415, 1530 3rd Avenue South, Birmingham, AL 35294, USA. Electronic address: schwebel@uab.edu. 4. Division of Cancer Prevention and Control, Epidemiology and Applied Research Branch, CDC, 1600 Clifton Road Atlanta, GA 30329, USA. Electronic address: zab3@cdc.gov. 5. Division of Adolescent and School Health, CDC, 1600 Clifton Road Atlanta, GA 30329, USA. Electronic address: nel6@cdc.gov. 6. Department of Health Promotion and Behavioral Sciences, University of Texas School of Public Health, 1200 Pressler Street, Houston, TX 77030, USA. Electronic address: Susan.Tortolero@uth.tmc.edu. 7. Department of Health Promotion and Behavioral Sciences, University of Texas School of Public Health, 1200 Pressler Street, Houston, TX 77030, USA. Electronic address: Paula.M.Cuccaro@uth.tmc.edu. 8. Department of Health Behavior, UAB Center for the Study of Community Health, 1665 University Boulevard, Birmingham, AL 35294, USA. Electronic address: sdavies@ms.soph.uab.edu. 9. Division of General Pediatrics, Boston Children's Hospital and Department of Pediatrics, Harvard Medical School, Enders, 300 Longwood Avenue, Boston, MA 02115, USA; Kaiser Permanente School of Medicine, 100 South Los Robles Avenue, Pasadena, CA 91106, USA. Electronic address: mark.schuster@childrens.harvard.edu.
Abstract
RATIONALE: Studies of inequities in diffusion of medical innovations rarely consider the role of patient-centered care. OBJECTIVE: We used uptake of the human papillomavirus (HPV) vaccine shortly after its licensing to explore the role of patient-centered care. METHODS: 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. RESULTS: We did not find evidence that the association of patient-centeredness with vaccination varies by parent education. In contrast, parent ratings of providers' 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 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. CONCLUSION: The results indicate that patient-centered care, which has been a relatively understudied factor in the unequal diffusion of medical innovations, 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.
RATIONALE: Studies of inequities in diffusion of medical innovations rarely consider the role of patient-centered care. OBJECTIVE: We used uptake of the human papillomavirus (HPV) vaccine shortly after its licensing to explore the role of patient-centered care. METHODS: 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. RESULTS: We did not find evidence that the association of patient-centeredness with vaccination varies by parent education. In contrast, parent ratings of providers' 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 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. CONCLUSION: The results indicate that patient-centered care, which has been a relatively understudied factor in the unequal diffusion of medical innovations, 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.