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Background Seasonal influenza vaccination uptake among 2-3-year-olds in Wales remains below target levels, despite national efforts. During the winter of 2024 to 2025, Hywel Dda University Health Board (HDUHB) implemented a nurse-led telephone intervention to address low uptake and explore barriers to vaccination. This study evaluates the effectiveness of this direct outreach initiative in improving vaccination rates, and describes the most common barriers to vaccination (both logistical and hestiancy-related) identified by parents of unvaccinated children.Methods Between December 2024 and March 2025, nurses contacted 406 parents of unvaccinated 2-3 year old children across 16 GP practices with the lowest influenza vaccine uptake rates. Pop-up vaccination clinics were established to facilitate access. Callers followed a structured script incorporating motivational interviewing techniques, and parents were offered support to access vaccination via booking with their GP, attending a pop-up clinic, or offering a home visit for eligible children. Data were collected on vaccination intentions, barriers (logistical vs. hesitancy-related), and outcomes.Results Of 406 parents, 365 (89.9%) were successfully contacted. 44.9% expressed intent to vaccinate, yet only 21.7% of children were ultimately vaccinated. Logistical barriers to vaccination (for example scheduling conflicts, illness) were significantly more likely to be overcome than hesitancy-related concerns (such as safety fears or a preference for natural immunity). Among parents citing logistical barriers at the time of the call, 39.3% ultimately vaccinated their child, compared to 0% among those citing hesitancy. Pop-up clinics achieved a 51.8% attendance rate.Conclusion Nurse-led calls effectively addressed logistical barriers but were insufficient to overcome vaccine hesitancy. These findings highlight the need for differentiated strategies to improve vaccination rates, including direct outreach for access issues and sustained, trust-based engagement for hesitant populations. Strengthening GP-led reminder systems and tailoring communication approaches may enhance future vaccination campaign effectiveness.