Ce travail contient une investigation sur la théorie phénoménologique de la signification. L'idée-clé du projet est d'expliquer la constitution de la signification au moyen des analyses de l'intentionnalité. Nous avons étudié différents actes intentionnels qui fonctionnent dans l'expression et dans la construction des significations. Nous avons étudié à cet égard, d'abord, l'acte d'expression primordiale, dans lequel le contenu d'une intuition est élevé au domaine de l'idéal, puis les actes de synthèse catégorielle, dans lesquels d'autres significations se constituent en absence de leur propre intuition. Nous avons puis étudié les effets de la théorie de la signification à la conception de la logique pure. En conséquence, nous avons discuté que la sémantique dialogique est un cadre adéquat, selon le phénoménologie, pour interpréter le raisonnement logique et pour expliquer la signification des constantes logiques. Nous avons également discuté la signification de certains connecteurs logiques, et leurs formalisations, en utilisant notre méthode phénoménologique-dialogique. / This work contains an investigation on the phenomenological theory of meaning. The key idea of the project is to explain the constitution of the meaning by means of the analyses of the intentionality. We have investigated different intentional acts which are functioning in expression and in constructing the meanings. In this regard we have studied, first, the act of primordial expression, in which a content of an intuition is raised to the realm of the ideal, and then the acts of categorial synthesis, in which further meanings are constituted in the absence of their proper intuition. We have investigated the effects of the theory of meaning to the conception of pure logic. Dialogical semantic is shown to be an adequate framework to interpret logical reasoning and to explain the meaning of the logical constants as well. We have also discussed the meaning of some logical connectives, and their formalizations, using our phenomenologico-dialogical method.

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Die Arbeit basiert auf fünf Aufsätzen. In diesen wird über vier Experimentserien berichtet, die das individuelle Entscheidungsverhalten von Versuchspersonen in ähnlichen, aber verschieden komplexen Situationen erheben. Es wird ein experimentelles Szenario vorgestellt, mit dessen Hilfe Rückschlüsse auf das Sparverhalten gezogen werden können. Es werden stilisierte Fakten des Verhaltens realer Entscheider identifiziert, die sich in solchen Situationen wesentlich vom rationalen Verhalten des "homo oeconomicus" unterscheiden. Eine der Experimentserien wurde im Internet durchgeführt, wobei zusätzlich generelle Aspekte von Internetexperimenten untersucht werden. / This thesis is based on five studies. These studies report on the individual behavior of experimental subjects in four experiments. The experimental situations are similar, but differ in their complexity. With the introduced experimental setup, one can draw conclusions about savings behavior. Stylized facts about the behavior of real decision makers are identified, which differ in such situations substantially from the rational behavior of the "homo oeconomicus". One of the experiments was conducted via the Internet. In this part also general aspects of Internet experiments are investigated.

HIV, syphilis, malaria, and anaemia are major causes of adverse pregnancy outcomes in sub-Saharan Africa (SSA). Despite global and national policies advocating for screening of these conditions, only HIV testing has achieved good coverage, precluding early detection and appropriate management in pregnancy. Rapid pointof-care tests (POCTs) provide an opportunity to integrate diagnosis and provide timely treatment of these conditions in rural antenatal care (ANC) settings. After an introductory chapter, a review of the literature on these four conditions in pregnancy is presented with a focus on SSA. The thesis then shifts attention to Kenya, a country that embodies many of the disease challenges and health system characteristics of the region. Kenyan ANC policy recommends testing for HIV, syphilis and anaemia and preventive strategies for malaria. The following chapters are comprised of three linked studies conducted in western Kenya, that use different methods to progressively investigate the implementation success of integrated point-of-care testing (POCT) for HIV, syphilis, malaria and anaemia at seven peripheral dispensaries. Baseline data confirmed that testing requirements for syphilis, malaria and anaemia are not currently met at dispensary level. We implemented an intervention where test kits were supplied and training plus supervision were provided to enable healthcare workers to conduct integrated POCT for pregnant women. Adoption and fidelity were measured quantitatively using exit interviews, antenatal registers and proficiency scores (Study 1: Integrating point-of-care testing (POCT) for HIV, syphilis, malaria and anaemia in antenatal care at dispensary level in western Kenya: an implementation study) while acceptability, appropriateness and feasibility were assessed qualitatively (Study 2: Exploring healthcare workers and pregnant women’s perspectives on appropriateness, acceptability and feasibility of integrating point-of care testing: A qualitative study). Our findings show that the innovation was highly adopted, meaning almost all pregnant women received the essential tests. This was supported by the qualitative findings where healthcare workers and pregnant women found the innovation acceptable and appropriate. However, fidelity to clinical management guidelines can still be improved. Our qualitative findings provide some explanation for these gaps. One common sentiment among interviews with healthcare workers was that workload was perceived to be a barrier to providing quality care. We explored this further with discrete-event simulation modelling (Study 3: Investigating the operational impact of integrating HIV, syphilis, malaria and anaemia point-of-care testing in antenatal care clinics in western Kenya: a discrete event simulation model) and found the healthcare workers were actually under-utilized. This suggests that nurses should, in theory, have sufficient time to deliver essential ANC services. While integrating POCT addresses one gap, additional interventions to support and supervise healthcare workers are needed to ensure appropriate and high quality of care. An integrated approach to health systems strengthening and more investment in implementation and translation research using multi-methods are needed.

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