Parental preferences for immunization advisory clinic settings for children with special health care needs and associated factors in Shanghai: A cross-sectional study

Children with special health care needs (CSHCN) face persistent immunization inequity despite high overall childhood vaccination coverage. Immunization advisory clinics (IACs) have expanded in China, yet parental preferences for different IAC settings remain poorly understood. This cross-sectional survey was conducted at the IAC of Children's Hospital of Fudan University, Shanghai, between October and December 2023. Parents of CSHCN younger than 14 y with incomplete National Immunization Program schedules were invited. The primary outcome was parental preference for IAC setting (community clinic, general hospital, or children's hospital); the secondary outcome was preferred vaccination-assessment provider under discordant recommendations. Multinomial and binary logistic regression models identified associated factors, adjusted for child, parent, and vaccine-attitude covariates. Sensitivity analyses were stratified by medication status. Reporting followed the STROBE statement. Of 102 questionnaires, 101 were valid (99.0% response rate). 51.0% of parents preferred community clinics, 25.7% preferred children's hospitals, and 23.3% preferred general hospitals. Parent Attitudes about Childhood Vaccines (PACV) score was not independently associated with setting preference. Parents of girls were more likely to prefer general hospitals (adjusted RRR, 7.02; 95% CI, 1.50-32.77), whereas lower household income was associated with reduced preference for general hospitals (adjusted RRR, 0.14; 95% CI, 0.03-0.75). Sensitivity analyses yielded consistent findings. Parental preferences for IAC settings among CSHCN families are shaped by child and socioeconomic characteristics rather than by vaccine hesitancy alone. Hybrid hospital-community delivery models and standardized referral pathways may improve vaccination equity for medically complex children.