Theory of change example: a free clinic

What it shows

A theory of change drawn as an outcomes pathway, following Taplin and Clark’s Theory of Change Basics (2012). Early outcomes sit at the bottom, the long-term outcome at the top, and each outcome is a precondition of the one above it.

Numbered orange circles mark interventions, placed on the arrow into the outcome each one helps bring about. Dashed circles beside the arrows mark assumptions, conditions the plan takes as already in place, listed as A1 to A5.

The example is the same Mytown Free Clinic as the logic model example, taken from the W.K. Kellogg Foundation’s guide, so the two diagrams can be compared directly.

How to read it

1. 1

   Start at the top with the long-term outcome: fewer uninsured men aged 40 to 55 seeking care in the emergency room, with a target of 25% fewer within 5 years.

2. 2

   Work down by asking what must be in place first. A medical home at the free clinic (target: 15% more within 5 years) leads to more annual physicals and follow-up visits, which lead to the long-term outcome.

3. 3

   Four early outcomes feed the medical home: donated space, volunteer staff, patients who see the need for a medical home, and referrals from the emergency room.

4. 4

   Each dashed tag points to an assumption in the list. If an assumption fails, for example the hospital does not support the clinic, the link it sits on is at risk.

Interventions and assumptions

• Interventions: 1 secure a facility; 2 recruit and train volunteers; 3 patient education; 4 create a free clinic.
• A1: affordable primary care reduces emergency visits, as it did in Anothertown.
• A2: the hospital will support a free clinic.
• A3: Mytown has a history of successful volunteer programs.
• A4: the clinic can find and operate in donated space.
• A5: the Medical Society will encourage volunteers and provide ongoing support.
• Method: Taplin and Clark (2012). Example, targets and assumptions: W.K. Kellogg Foundation (2004). Kellogg sets these out in its exercises and templates; arranging them as a pathway is this diagram’s illustration.

Ways to use it in teaching

• Show the logic model and this pathway side by side and ask students what each one makes visible that the other does not.

• Have groups build a pathway backwards from a long-term outcome of their own, asking at each step what must be in place first.

• Ask students to pick one assumption and say what evidence would show it holds, or what the program would do if it did not.

Sources

• Taplin, D. H., & Clark, H. (2012). Theory of change basics: A primer on theory of change. ActKnowledge.
• Theory of change. (n.d.). In Wikipedia. Retrieved October 19, 2026, from https://en.wikipedia.org/wiki/Theory_of_change
• W. K. Kellogg Foundation. (2004). Logic model development guide. https://19january2021snapshot.epa.gov/sites/static/files/2015-09/documents/logic-model-development-guide.pdf