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Updated: Jul 9, 2025

Using Visual and Narrative Methods to Achieve Fair Process in Clinical Care
Published on: February 16, 2011
Equity-related 'knots' in theory of change development: Conceptualization and case illustrations
Emily Gates1, Kathy Chau Rohn2, Kiruba Murugaiah3
1Measurement, Evaluation, Statistics, and Assessment Department, Lynch School of Education and Human Development, Boston College, USA.
Abstract:
Theory of change (ToC) is an approach widely used to guide planning, implementing, and evaluating change initiatives. While there is substantial guidance, there has been little attention on equity within ToC research and practice. We propose and illustrate the metaphor of 'knots' to frame practical and ethical challenges that arise when centering equity within ToC processes. Drawing on our experiences using a ToC approach in two case examples, we identify and illustrate five equity-related knots: (a) clarify root causes, pathways, and success; (b) facilitate participation across power and perspective differences; (c) integrate research evidence and practitioner knowledge; (d) represent complex change visually; and (e) creatively navigate constraints. We show why framing these as knots can help practitioners make wise judgments within the circumstances and close with recommendations for including knots in ToC processes, reporting, and guidance.
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