Background: Annually, thousands of women are exposed to violence and murder by male relatives in the name of family honour. In Sweden young women with immigrant backgrounds consult primary healthcare services for problems related to the protection of 'family honour' (PFH). However, there is little knowledge about how to manage this specific type of family violence in the primary healthcare systems of industrialized countries. Aim: To generate a theoretical model to promote knowledge about how youth clinic (YC) personnel in Swedish primary care perceive and manage problems related to the PFH. Methods: Seven midwives and five counsellors at four YCs in Stockholm suburbs participated in four group interviews. Data were analysed according to the grounded theory method. Results: The YC staff's main concern is to avoid making the young womens' situation worse with their constant anxiety about having breeched the 'honour rules'. Three consecutive steps have been discerned in the worry analysis process to help the girls struggling with problems related to PFH: (i) creation of a refuge where their secret can be safely disclosed, (ii) risk assessment consisting of assessing the degree of the young women's anxiety, the risk of disclosure of the secret and the risk of repercussions if the secret is disclosed and (iii) worry-reducing measures, which may take the form of four different strategies: empowerment, keeping the secret, mediation and secondary prevention. Conclusion: Youth clinics have a key role in preventing repercussions caused by problems related to PFH. The study provides a theoretical model that can be used as a tool in preventive work with young women anxious about honour-related family violence. The findings were presented to a group of midwives and counsellors for validation. © 2009 The Authors. Journal compilation © 2009 Nordic College of Caring Science.

Midwives Youth clinics Counsellors Primary health care Honour-related violence Family honour

sexual behavior psychological aspect interpersonal communication human ethnology Young Adult Humans migrant family attitude psychology Domestic Violence counseling Emigrants and Immigrants female Truth Disclosure prevention and control Article Family Relations adult migration midwife Midwifery family relation utilization Utilization Review primary health care