Abstract
Despite the widespread implementation of puppets as an art-based intervention for health promotion and behavioral change, no prior synthesis of the literature on the effectiveness of puppetry on sexual health outcomes exists. The purpose of this study was to describe the methods, efficacy, and evidence base for puppetry as a channel for sexual health education interventions across global settings and demographics. A scoping review was conducted using the PICOS framework and PRISMA-ScR guidelines, examining studies across 16 databases up to and including March 1, 2025. Twenty-seven studies (N = 27) met the inclusion criteria. In summary, puppetry interventions spanned diverse global settings, sexual health domains, and populations, with a notable recent rise in implementation. Findings indicate puppetry can improve sexual health behaviors and related antecedents. However, the evidence base remains limited. Recommendations for interventions include involving familiar facilitators for intervention delivery, continuous reinforcement of educational material, and participatory methods to enhance program inclusivity, relevance, and continuity. Comprehensive evaluations that include rigorous study design, robust intervention descriptions, and theoretical foundations to guide study design and analysis will improve future research to further demonstrate how puppetry improves sexual health outcomes and cultures of respect, equity, and sustained behavior change.