BACKGROUND AND PURPOSE: Influenza represents a considerable worldwide health problem. Vaccination is the only preventive measure, capable of reducing mortality and morbidity of influenza in all age groups. The objective of this study was to assess the extent of influenza vaccination coverage in the seasons 2002/2003, 2003/2004 and 2004/2005 in Germany, to understand the driving forces and barriers to vaccination, and to determine vaccination intentions for the subsequent winter. METHODS: The authors conducted a random-sampling, telephone-based household survey among noninstitutionalized individuals representative of the population aged > or =14. The surveys for the different seasons used the same questionnaire and were subsequently pooled. Four target groups were determined for analysis: (1) persons aged > or =60; (2) people working in the medical field; (3) persons suffering from chronic illness; and (4) a composite group made up of persons aged > or =60 or working in the medical field or suffering from a chronic illness. RESULTS: The overall sample consisted of 5,990 people. The influenza vaccination coverage rate in Germany increased from 22.3% in season 2002/2003 to 25.1% in season 2003/2004 and increased again to 26.5% in season 2004/2005. This increase is statistically significant (p = 0.007). The composite group coverage rate increased from 40.0% (2002/2003) to 42.2% (2004/2005). The driving forces and barriers to vaccination did not change over the years. The most frequent reasons for being vaccinated given by vaccinees were: influenza considered to be a serious illness which people wanted to avoid, having received advice from the family doctor or nurse to be vaccinated, and not wanting to infect family and friends. Reasons for not being vaccinated mentioned by people who have never been vaccinated were: thinking about it, however, not being vaccinated in the end, not expecting to catch influenza, and not having received a recommendation from the family doctor to be vaccinated. Major encouraging factors to influenza vaccination were: recommendation by the family doctor or nurse, more available information on the vaccine regarding efficacy and tolerance, and more information available about the disease. CONCLUSION: The vaccination coverage rate increased by 4.2% over the three seasons. The family doctor is the most important source of encouragement for people to be vaccinated against influenza. It seems that the public would be more likely to be vaccinated if they had more information on the efficacy and tolerance of the vaccine, as well as the disease. The authors therefore suggest that family doctors be better informed on influenza vaccine and the disease itself, so that they can actively inform their patients on these topics.