Organizational interventions aim to improve worker health and wellbeing through changing the work environment. This is conducted by making changes to work policies, practices, and procedures. Determining what to change and how to make these changes involve several techniques, but best practices focus on participatory processes involving workers, managers, and key stakeholders with a responsibility for managing worker health and wellbeing in the workplace. Despite participation being the recommended method to determine the "what and how" of these changes, there is little consensus about what participation is and how it works. The evidence of the effectiveness of these participatory processes is unfortunately quite mixed. In this chapter, we discuss these issues and focus on three key challenges of participation in organizational interventions. First, we discuss issues around different forms of participation, including the advantages and disadvantages of direct and indirect participation and what form of participation may be effective during the different phases of the intervention process. Second, we discuss how participation should work, that 2 is the underlying mechanism for what makes participation facilitate a successful intervention outcome. Third, we discuss how diverse workplaces may challenge traditional ways of conducting organizational interventions.