Behavioural skills and self‐efficacy
Participants reported learning behavioural skills to overcome adherence challenges during counselling sessions and support clubs, and these skills were supported by phone and SMS contacts and the pill‐carrying case. Frequently mentioned problem‐solving approaches included: reminder systems for daily pills, ring replacement or study visits; discreet use to avoid unwanted disclosure; managing product storage at home and while travelling; practices to reduce or treat side effects; ignoring or dispelling rumours and stigma; and strategies to disclose product use and gain adherence support from people outside the study. Many participants successfully addressed their product use challenges by applying these skills and mobilizing study resources. However, a few reported ongoing challenges with food, side effects or other factors; not receiving adequate counselling or support on disclosure; not receiving the texts or phone calls they signed up for; or that their attempts to gain external support were unsuccessful.Participants reported that counsellors helped them identify and prioritize their own adherence challenges and determine the best problem‐solving strategies. This approach increased AGYW's perceived self‐efficacy to address these challenges and imparted a sense that it was their responsibility to take or leave the counsellors’ advice.

Problem‐solving usually occurred in this manner and through brainstorming with peers, but counsellors also provided more direct support at times, for example by meeting with family members or partners to facilitate product use disclosure or dispel rumours, or by referring participants to clinicians to manage side effects. The phone calls and SMS contacts facilitated fast access to this support, helping AGYW address side effects quickly instead of having to wait until their next scheduled visit. Participants’ sense of self‐efficacy was strengthened by seeing these approaches succeed for themselves and their peers.Receiving green DLF results built additional self‐efficacy by validating participants’ adherence efforts. Although AGYW could usually predict their results from their actual product use, many relied on the DLF to gauge whether they were truly protected, and felt stress and uncertainty about their protection levels when results were delayed. Conversely, receipt of yellow or red DLF was critical in helping participants access counselling on behavioural skills by opening the door to honest discussions of adherence challenges:

