Objectives: The overall aim of this research was to describe the health-seeking behaviours (HSBs) of people in rural Makwanpur, Nepal, and to analyse the patient, household, community, health-system, knowledge and illness factors, and the psychological, social and cultural processes which explain these behaviours. Background: Much about the health status of populations and individuals can be understood by studying how people utilise their health services and the factors associated with this utilisation. HSB studies act as a starting point for the planning of health programmes and the structuring of health systems. Nepal, with its shortage of health providers and funding, its low service usage and its pluralistic medical landscape provides an interesting setting in which to examine HSBs. Most health policies in this context have been devised without taking into account the perspectives of the system users. Moreover, limited formal research on this topic has been carried out in this context. Methods: This study involved a mixed-methods, explanatory sequential design consisting of two phases – quantitative data collection followed by qualitative data collection. Quantitative data was collected using a cross-sectional household survey carried out in 2,334 households across ten VDCs in Makwanpur district between April 2011 and August 2011. Households were selected using a random sampling method. The survey asked about care-seeking in response to an acute episode of illness in the previous one month. Qualitative data was collected after the quantitative data using semi-structured household interviews (n=90) in three VDCs between November and December 2012. The Qualitative interviews were designed to compliment the quantitative findings and to determine the explicit factors associated with care decisions. Results: Of the 2,334 households surveyed,46% had at least one episode of illness in the month prior. The majority of illnesses were infectious or parasitic diseases (42%). Of those households experiencing illnesses, 69% chose to seek care outside of the home; 22% used traditional healers, 37% used allopathic providers and 12% opted for pharmacies as a first option. Sixteen did nothing to address their illnesses, sighting geography, finances, workload and lack of severity as the reasons. Regression models revealed that a host of different patient, household, community, illness, health facility and knowledge factors were associated with care decisions depending on the decision, but illness factors had the greatest impact overall on whether or not a household sought some care or care outside of the home, while household level factors had the greatest impact on the type of care sought outside of the home and the length of delays before seeking care. Patient gender had an impact on whether or not allopathic care was used at least once. Qualitative results revealed that health facility factors were also equally important in determining households’ conscious decision-making about specific providers. Conclusions: Overall it appears that people in Makwanpur are not underutilising health services as suspected. Households use certified government providers most frequently to address their illnesses, and do not rely too heavily on traditional healers or informal providers exclusively. The results indicate that while illness and household factors are important, in order to improve HSBs and increase allopathic care utilisation, a focus should be on improving health service delivery rather than on changing HSBs. However, in order to decrease delays in care-seeking, a focus should be made to reduce household-level barriers to care as well.

Cette recherche s’interroge sur les pratiques et les usages d’Internet et de Windows Live Messenger. Elle dresse un panorama des usages d’Internet et de WLM chez l’adolescent et analyse leur appropriation dans une phase où l’individu est en expérimentation et en quête d’identités sociale et culturelle. Nous étudions les spécificités de WLM et les types de sociabilité qui se tissent par son biais. Les résultats mettent en évidence la permanence ou l’évolution des pratiques des objets étudiés. Nous nous interrogeons sur les traits permettant de définir, socialement et techniquement la « culture jeune » et mettons en exergue un ensemble de critères spécifiques à la diffusion et à l’appropriation d’un dispositif par les adolescents. Comprendre et analyser l’usage social de WLM permet de saisir les termes relationnels de son insertion et les changements sociaux et culturels induits par les pratiques. Pour cela, le corpus est constitué de deux enquêtes séparées de 3 ans auprès de collégiens, lycéens et étudiants de Côte d’Or. D’un point de vue théorique, le travail s’appuie sur la sociologie des usages et permet d’étudier Internet et la WLM comme des dispositifs socio-techniques. Cette perspective questionne les concepts de culture numérique, de fractures numériques et sociales, d’usage social et de lien social. Une dernière partie de cette thèse établie des préconisations de développement des TIC en Bourgogne et en zone rurale. Nous avons procédé à trois entretiens avec les sénateurs de Côte d’Or afin d’avoir la vision politique d’acteurs de terrains locaux et nationaux, sur le rôle et les enjeux des TIC dans l’aménagement du territoire et dans leurs implications au service du lien social et de la cohésion sociale. / This thesis examines the practices and uses of the Internet and of Windows Live Messenger. It charts out different uses of the Internet and WLM among young people, and analyses the way they are adopted, at a time when the individual is experimenting with social and cultural identities. It deals with the specificities of WLM, and the types of sociability associated with it. The results of the study show that practices linked to the objects studied evolve in some areas, while remaining stable in others. The thesis seeks to establish the key traits which go to make up, socially and technically « young people’s culture », and lays out the different criteria specific to the propagation and adoption of a technical artifact by young people. Understanding and analyzing the social uses of WLM allows us to identify the relational context surrounding its insertion and the social and cultural evolutions implied by associated practices. For this reason, the study is based on a corpus composed of two empirical data-sets, recorded three years apart, involving middle-school, high-school and university students from the Côte d’Or region of Burgundy. From a theoretical viewpoint, the study is based on user sociology and approaches the Internet and WLM as social and technical artifacts. This perspective questions the concepts of digital culture, of digital and social divides, of social use and of social relations. A final part of the thesis applies the findings to the development of ICT in Burgundy and in rural regions, in the form of a set of guidelines. A series of three interviews were conducted with local politicians elected to the French senate, in order to establish the vision of political leaders both on local and national levels, concerning the role and the issues surrounding ICT from the point of view of urban development, and their implications, in terms of social relations, for maintaining social cohesion.