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This thesis is about the experience of Muslim British \nPakistani families coping with thalassaemia (a chronic, \ninherited blood disorder) and the implications for service \ndelivery. Its central concern is to illustrate that \nsimplistic and culturally-biased assumptions are an \nunsatisfactory base on which to devise health service \ndelivery for minority populations, and that with careful study \nit is possible to deliver culturally sensitive and \nappropriate services. \nThe thesis is written in four parts. The first part contains \nthe research methods and the clinical aspects of thalassaemia. \nIt also provides an introduction to the families in the study. \nThe British Pakistani population is considered in the context \nof migration to Britain, which has created a plural society \nrequiring adaptations to services to meet the diverse health \nneeds of the different ethnic minorities. \nThe second part deals with the socio-economic and cultural \nbackground of British Pakistanis in Pakistan: this (is) crucial to \nan understanding of their present situation. Family \ndynamics, marriage patterns and decision-making processes are \nexplored, as is the central role of religion and kinship \nnetworks in the lives of British Pakistanis. It also examines \ntheir settlement process and present living conditions and \nillustrates how the social structures prevalent in Pakistan have been re-established in England, albeit in a modified \nform. \nThe third part documents, using case studies, the experiences \nof British Pakistani families with thalassaemic children. \nThese are analysed to highlight deficiencies in health service \ndelivery and areas where cultural misconceptions exist. These \nareas require attention to provide an effective genetic \ncounselling service for this population. \nThe final part examines the social and clinical implications \nof consanguineous marriage. It gives the results of a study \nshowing increased frequency of consanguineous marriage among \nBritish Pakistanis than among Pakistanis in Pakistan. It then \nillustrates how kinship networks within communities practising \nthis marriage pattern provide an opportunity to offer a \ngenetic counselling service in a unique way, by making \npositive use of the practice. This proposed approach applies \nnot only to thalassaemia but also to other inherited diseases.