A grounded theory of program transfer: how an Aboriginal empowerment initiative became "bigger than a program"

National Aboriginal health research guidelines and researchers have called for programs that work in one setting to be appropriately transferred to other sites or situations. Yet the Aboriginal Australian health literature cites few examples of the successful transfer of programs and there has been little theoretical conceptualisation of the processes of transfer and implementation. In this study, I constructed a grounded theoretical model of the process underlying program transfer, based on the Aboriginal Family Wellbeing (FWB) empowerment program. Using a constructivist grounded theory methodology and applying the commensurate lenses of post-modern situational analysis and post-structural critical theory, I designed a three-part research approach. First, I developed a historical account of FWB transfer by mapping, charting and graphing data, primarily from FWB documents. Included were descriptions of the individuals and organisations responsible for program transfer, the extent of transfer and adaptation, and the enabling and constraining structural conditions. Second, I constructed a theoretical model of program transfer using constructivist grounded theory and situational mapping methods. Data was generated by conducting in-depth interviews with 18 research respondents who were active in FWB transfer. These accounts were analysed to determine why and how they transferred the program. Data was categorised into higher order concepts and identified both the central concern of research respondents and the basic process that facilitated that concern. Third, I established the significance of the theoretical model for practice and policy by comparing it with established models from the Aboriginal Australian and international knowledge into action literatures. In the resultant historical description, I recount the genesis of FWB in Adelaide in 1993, and its transfer by collectives of individuals working within and across diverse Aboriginal community organisations, government departments, researcher organisations and non-government and private organisations. Transfer resulted in the delivery of the program to approximately 3,300 participants across 56 sites and situations. There was significant program adaptation, with reinvention occurring through five social arenas: community development and employment, training and capacity development, health promotion, empowerment research and school education. Program transfer was affected by structural conditions from a continuum across Aboriginal and Western domains. Constructing the grounded theory, I determined the impetus for program transfer as supporting inside-out empowerment. The individuals and organisations transferred the program as a vehicle for supporting the empowerment and agency of individual participants and a consequent ripple effect to family members, organisations, communities and ultimately reconciliation with Australian society at large. Embracing relatedness was the three-dimensional process by which program transfer occurred. It included relatedness with self, others, and structural conditions; all three were necessary at both individual and organisational levels in order for program transfer to occur. The process of embracing relatedness involved four sub-processes: meeting a need, taking control to make choices, listening and responding, and adding value. Meeting individuals' needs facilitated agency for individuals to take control to make choices. The strengthened capacity of individuals facilitated listening and responding to organisational needs, priorities and aspirations; and adding value to organisations, services and policy. The enactment of these four sub-processes resulted in further iterations of program transfer. The study findings are consistent with Aboriginal Australian studies of empowerment and relatedness and international knowledge into action theories. However, the theoretical model of supporting inside-out empowerment by embracing relatedness is significant for practice and policy in three ways. First, the impetus of empowerment for translating knowledge into action through program transfer suggests that greater attention is required to support Aboriginal initiatives that enhance empowerment. Second, emphasis of approach on embracing relatedness suggests the importance in change processes of initiatives that facilitate interpersonal and interorganisational multi-agent networks, partnerships and collaborations. These tend to be poorly resourced and under-researched in the context of Aboriginal Australian development, health and wellbeing, and education. Third, the four sub-processes of meeting a need, taking control to make choices, listening and responding, and adding value imply that personal empowerment supports organisational and interorganisational change, and vice versa. Hence, change efforts can be entered at individual or organisational levels. Thus, the theory of program transfer, supporting inside-out empowerment by embracing relatedness, offers new insights into the process underlying program transfer across Aboriginal Australian sites and situations.