The scientific literature regarding preventive occupational health and safety activities in small enterprises has been reviewed in order to identify effective preventive approaches and to develop a future research strategy. During the last couple of years, there has been a significant increase in the number of studies of small enterprises, but the research community is scattered between many different disciplines and institutions. There is a lack of evaluation of intervention studies, both in terms of effect and practical applicability. However, there is sufficiently strong evidence to conclude that employees of small enterprises are subject to higher risks than the employees of larger ones, and that small enterprises have difficulties in controlling risk. The most effective preventive approaches seem to be simple and low cost solutions, disseminated through personal contact. It is important to develop future intervention research strategies which study the complete intervention system: from the intermediaries through dissemination methods to the resulting preventive activities of the small enterprises.