Table 1.

Reactions to Session Recordings and Ratings

Theme	Subtheme	Illustrative Quotes
Session Recordings	Counselor Reactions	Initially it was -- because it’s very scary and it’s intimidating, I would say, because when you’re not sure what you’re doing, it’s very hard to know that you are being recorded and somebody’s going to be listening to your mistakes. (Participant ID 53)
		When time goes on, you get to be comfortable and forget about the recorder and talk to the person in front of you. So, the minute you forget that you’re being recorded, you get to relax. (PTID 28)
		No, it was very nice to have the sessions recorded because it builds a record of you as the counselor working with your participant what you were talking about. Because with the record, you can also replay it and then you can hear yourself what you were saying to the participant. That equips you so that you could be able to pick up even your mistakes. That it’s also a learning curve for you not to repeat what we have done on that record. (PTID 25)
		For me, as a counselor, it benefited me a lot. I would review my work even with my peers. I would sit together and listen and comment each other, and also correct each other, which also I think made our team stronger. So, recording was good. (PTID 38)
		I believe it also influenced the accuracy of the data. Because if someone knows that they’re being recorded, they become not friendly and comfortable to tell everything. (PTID 41)
	How Counselors Presented Recordings to Participants	Some of them, they didn’t want to be recorded because of time. They would say that “I’m going to work. I don’t want you to record it.” (PTID 25)
		Even the person that refused the previous month, the following month, they will agree as soon as we made them realize that, even if you disagree to have a recording, I’m still going to follow the same flip chart. So don’t think that you’re going to spend five minutes. We are still going to spend the time to discuss everything that you need to discuss in a session. (PTID 42)
		One thing that I appreciate is that, the team actually said…when you feel a participant is in a hurry and they won’t be able to finish right through the 20 minutes, there are some parts you can cut... if a participant wants to go early, we would try to make the session, even for five minutes, or eight minutes. (PTID 16)
		Even if it’s sitting between me and her, it’s far away in the desk, I will make sure that I pull it towards me, so that she is – make her understand, “Oh, she’s recording herself, not me.” Yeah, so I put it as far away from her, as close to me as possible. (PTID 53)
		The people that will be listening to it won’t be trying to evaluate you or something. But they are listening to what I am saying to you, how I’m conducting the session. They are doing that because they want to help me be the best counselor for you. So you will see a person smiling, because they will feel that I’m doing this for them –- that it’s best for them at the end. (PTID 42)
		You have to explain to them that the people at the site, they won’t listen to the recording. It’s between you and the participants. They are not staff members. They won’t listen to your recordings. And that you are sending their recording to America, so no one in the clinic will know what you were talking about. So you have to reassure the participants about confidentiality. (PTID 04)
	Participant Reactions	I don’t like this recording thing… It takes a long time to get counselled… Maybe you speak soft or something. Sometimes you don’t feel like talking or you just want to listen. (Participant 687, Month 3 Visit)
		This [counseling] is now advanced with your recordings and the books [meaning flip charts] you now have which you open to read… it is now of high standard. (Participant 254, Month 3 Visit)
		When we are not recorded, study staff being human at times they will be tired and they would have done it for a long time so they will be using short cuts [laughs]. But when there is recording we say it all, there is nothing that is left over. (Participant 892, Enrollment Visit)
Session Ratings		I was like, these people, they want to judge us. (laughter) I thought that. I was feeling uneasy. And I remember, I could not open the first feedback I had. (PTID 43)
		I had problems to ask open-ended questions all the time. But with the comments, which were said in a very nice way, I found myself improving with the open-ended questions. (PTID 33)
		The raters were -- they would say, you have done this portion very well. And then when you look back and remembered it, oh, it means that if I’m doing my counseling and I’m touching on this and this and this, that’s doing it very well. Because you also like to be reassured. You also like to be shown where we have done well. (PTID 42)
		If we were just doing the sessions and not having the feedback, where would we know when we are not doing it right? (PTID 22)
		So, if I would have a three today for the way I would have handled a certain session, the next time I would find I have a four, and then next time I have a five -- this means I -- it made me work. It made me improve myself. It made me fix my mistakes. It made me have confidence in my work. (PTID 33)
		It was a big impact. Can I call it tremendous, it was a tremendous impact. Why? You know, like when you’re counseling, no one realizes that you’re doing something good, not until there is some behavior change has been realized. And even if it is realized, someone will not think that’s the impact of talking to someone like that. (PTID 56)
		Even at work, when you just talk about counseling and they want to know how your counseling is, I can just say, Oh, I did Options counseling. Here are my ratings. So, I can use them as part of this work. (PTID 27)
		Putting the face to the rater or to the reviewer, it helped a lot...having an actual relationship with the rater, it helped that it’s not a computer or is not the teacher. It’s just another human being. It’s just a colleague that looks after my work. It helped in that way, knowing that. (PTID 41)