Objective: To evaluate a health leader-focused church-based breast cancer prevention intervention in relation to congregants' intended participation, congregants' actual participation, and perceived health outcomes at both individual and church levels using socio-ecological and theory of planned behavior frameworks. Method: Participants for the study were African American adults (n = 52) from six churches in a North Florida county involved in implementing the 9-month, three-phase intervention. Using a pre/post without comparison group design, data were collected via self-administered surveys and analyzed using qualitative and quantitative (descriptive, analysis of variance, linear regression) procedures. Results: There was general alignment between congregants' intended and actual participation when analyzed by content, especially in the areas of food and nutrition and health education. Regarding the number of intended versus actual activities, there was a significant, negative change in physical activity, a slight decline in health education activities, but a slight increase in food and nutrition activities. No significant relationships were found between extent of participation and the individual health outcomes (health ratings, health status), but significant relationships were found between extent of participation and church health outcomes (perceived role of church in improving health, p < 0.001; perceived role of the pastor in improving health, p < 0.001). Conclusions: The findings demonstrate that (1) congregants may follow through and participate in church-based health activities in which they express interest and that are made available and (2) the extent of their participation may be influenced by the perceived role of both the church and the pastor in improving their health.