Design science research has developed strongly in the last decades with rich contributions to organization science and, more specifically, to organizational change. These contributions were not straightforward and cannot be obtained without strong epistemological and theoretical rigor. In the first part of this chapter, we show why it is critical to encompass a variety of design approaches and methods within a unified theoretical framework that underlines the logic and rationality – namely, the design theory—assumed in each type of design science research. In the second part, we use this framework to compare three families of design science research approaches and underline for each of them their methodological assumptions and the type of organizational changes they aim to achieve. We show that these streams account in different ways, and more or less explicitly, for design as a generative process that includes organizational change. We illustrate each of these approaches with specific research cases from the literature. Finally, we conclude with key insights for organizational change researchers and discuss how design science research could further contribute to the development of organizational change theory.