The Healthy Directions-Small Business randomized, controlled study aimed to reduce cancer risk among multiethnic workers in small manufacturing businesses by increasing fruit and vegetable consumption, physical activity, and daily multivitamin in take and decreasing consumption of red meat. The intervention incorporated participatory strategies and was built on a social-contextual framework that addressed people with varying cultural backgrounds and literacy levels. In addition, the intervention aimed to reduce worker exposure to occupational hazards. Process evaluation was conducted using quantitative and qualitative research methods. Quantitative results showed high levels of worker awareness of and participation in programs. Qualitative findings suggested that management support, worker input, and a history of social interaction between workers and management may have contributed to high participation rates. Future studies need to examine characteristics associated with participation and nonparticipation of both managers and nonmanagers to increase the likelihood of participation and ultimately improve health behavior.