Background Digital technologies may improve sexual and reproductive health (SRH) across diverse settings. Chatbots are computer programs designed to simulate human conversation, and there is a growing interest in the potential for chatbots to provide responsive and accurate information, counseling, linkages to products and services, or a companion on an SRH journey. Objective This review aimed to identify assumptions about the value of chatbots for SRH and collate the evidence to support them. Methods We used a realist approach that starts with an initial program theory and generates causal explanations in the form of context, mechanism, and outcome configurations to test and develop that theory. We generated our program theory, drawing on the expertise of the research team, and then searched the literature to add depth and develop this theory with evidence. Results The evidence supports our program theory, which suggests that chatbots are a promising intervention for SRH information and service delivery. This is because chatbots offer anonymous and nonjudgmental interactions that encourage disclosure of personal information, provide complex information in a responsive and conversational tone that increases understanding, link to SRH conversations within web-based and offline social networks, provide immediate support or service provision 24/7 by automating some tasks, and provide the potential to develop long-term relationships with users who return over time. However, chatbots may be less valuable where people find any conversation about SRH (even with a chatbot) stigmatizing, for those who lack confidential access to digital devices, where conversations do not feel natural, and where chatbots are developed as stand-alone interventions without reference to service contexts. Conclusions Chatbots in SRH could be developed further to automate simple tasks and support service delivery. They should prioritize achieving an authentic conversational tone, which could be developed to facilitate content sharing in social networks, should support long-term relationship building with their users, and should be integrated into wider service networks.

BACKGROUND Digital technologies may improve sexual and reproductive health (SRH) across diverse settings. Chatbots are computer programs designed to simulate human conversation and there is a growing interest in the potential for chatbots to provide responsive and accurate information, counselling, linkages to products and services, or a companion on a SRH journey. OBJECTIVE We conducted a realist review that aimed to identify assumptions about the value of chatbots for SRH and collates the evidence to support them. METHODS We used a realist approach that starts with an initial program theory and generates causal explanations in the form of context-mechanism-outcome configurations (CMOCs) to test and develop that theory. We generated our program theory, drawing on the expertise within the research team, and then searched the literature to add depth and develop this theory with evidence. RESULTS The evidence supports our program theory, which suggests that chatbots are a promising intervention for SRH information and service delivery, because chatbots offer anonymous and non-judgmental interactions that encourages disclosure of personal information, complex information in a responsive and conversational tone that increases understanding, links to SRH conversations within online and offline social networks, immediate support or service provision 24/7 by automating some tasks and signposting to services, and have the potential to develop longer term relationships with users who return over time. However, chatbots may be less valuable where people find any conversation about SRH (even with a chatbot) stigmatizing, for those who lack confidential access to digital devices, where conversations do not feel natural and where chatbots are developed as standalone interventions without reference to social contexts. CONCLUSIONS Chatbots in SRH could be developed further to automate simple tasks and support service delivery, should prioritize achieving an authentic conversational tone, should be developed to facilitate content sharing in social networks, should support longer term relationship building with their users and should be integrated into wider service networks.

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