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Background:  The use of chatbots may increase engagement with digital behavior change interventions in youth by providing human-like interaction. Following a Person-Based Approach (PBA), integrating user preferences in digital tool development is crucial for engagement, whereas information on youth preferences for health chatbots is currently limited.   Objective:  The aim of this study was to gain an in-depth understanding of adolescents' expectations and preferences for health chatbots and describe the systematic development of a health promotion chatbot.   Methods:  Three studies in three different stages of PBA were conducted: (1) a qualitative focus group study ( n  = 36), (2) log data analysis during pretesting ( n  = 6), and (3) a mixed-method pilot testing ( n  = 73).   Results:  Confidentiality, connection to youth culture, and preferences when referring to other sources were important aspects for youth in chatbots. Youth also wanted a chatbot to provide small talk and broader support (e.g., technical support with the tool) rather than specifically in relation to health behaviors. Despite the meticulous approach of PBA, user engagement with the developed chatbot was modest.   Conclusion:  This study highlights that conducting formative research at different stages is an added value and that adolescents have different chatbot preferences than adults. Further improvement to build an engaging chatbot for youth may stem from using living databases.

Participatory Development and Pilot Testing of an Adolescent Health Promotion Chatbot