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Background: The goal of hearing conservation programs (HCPs) is to prevent hearing loss, to preserve the existing hearing, and to provide workers with the knowledge and equipment they need to preserve their hearing. The South African mining industry has failed to achieve satisfactory results to reduce noise-induced hearing loss. Therefore, strategic and contextually relevant changes are required to reduce or eliminate occupational induced-hearing loss amongst mineworkers in South Africa. Objective: This study aims to develop an evidence-based theory on how HPCs work, for whom, and under what circumstances to reduce occupational-induced hearing loss amongst South African mineworkers. Method: A realist review will be conducted between October 2021 and February 2022 to examine how contextual factors trigger specific processes or behaviours (or "mechanisms") to reduce or eliminate occupational noise-induced hearing loss. This synthesis will follow five steps of Pawson's 2004 and 2005 guidance on conducting realist reviews: (1) developing the initial programme theory about hearing conservation programmes, based on a review of the scientific and grey literature, and multisector stakeholder workshops/interviews, (2) searching for evidence, (3) screening, selection, and appraisal of selected articles, (4) Data extraction and synthesis, and (5) refining the initial programme theory. In selected studies, patterns in context-mechanism-outcome (CMO) configurations will be uncovered across and between studies. This will help to support, refute or modify the initial programme theory, and ultimately produce a refined programme theory on why and how HCPs work and in what context. Results: The results of this study will be reported using the RAMESES guidance and reporting standards for realist synthesis. Implications: The complexity of HPCs poses challenges to their implementation to reduce occupationally acquired hearing loss to South African mineworkers. The findings from this realist review will provide recommendations both to policymakers and mineworkers on how to reduce occupationally induced hearing loss. [ABSTRACT FROM AUTHOR]