Diabetes and cardiovascular diseases (CVD) are major Jamaican public health issues. Churches may be untapped settings to extend reach and impact of diabetes and CVD prevention programs, particularly in low-resourced, rural Jamaican areas. We engaged the Jamaican Lifestyles Health Ministry Association Community Action Board in designing and conducting a health needs assessment (HNA) process to identify health conditions, priority health concerns, and potentially relevant intervention strategies to address concerns with their church-community members in rural areas. Findings from the HNA process (survey and community forum) were used by faith leaders to guide the design of a culturally-religiously tailored, multilevel diabetes/CVD risk reduction intervention, Project Faith Influencing Transformation (FIT)-Jamaica (JA). Use of HNA and collaborative intervention design processes were key to successfully completing the design of a faith-based health promotion intervention in JA churches in a timely manner.