Evaluation of Health on a Budget: A Health Promotion Program for Women Experiencing Homelessness

Main Article Content

Autumn Hackett, Class of 2016


In 2015, the researcher created "Health on a Budget," a five-session health promotion class to empower homeless women to live heathier lives on a budget. After enhancing the curriculum using the theory of planned behavior (Ajzen, 1991), the researcher reintroduced the program in 2016 and evaluated its effectiveness.

The researcher worked with stakeholders to identify key topics: health literacy in nutrition, portion control, cooking, exercise, and oral and foot hygiene. The researcher created objectives, lesson plans, and evaluation surveys that aligned with the theory of planned behavior. At the conclusion of each session, participants completed a survey that determined the completion of the objectives. Ten women residing at the Center for Transforming Lives shelter in Fort Worth participated in "Health on a Budget" in 2016. As a whole, the participants met all of the knowledge objectives, 80% of the attitude objectives, 80% of the behavioral intention objectives, 40% of perceived behavioral control objectives, and 20% of subjective norm objectives. Overall, the program had the greatest effect on the participants’ knowledge, attitudes, and intentions to perform healthy behaviors. The program was well-received by the participants, and the shelter stakeholders were very pleased with the program development and outcomes. Although the participants met most of the objectives, it is unclear if the women will take the knowledge they have and use it to change their day-to-day behaviors because of the complexity of their environment and circumstances. Changing shelter policies to improve the food environment and the nutritional content of the food would be more effective in promoting the health behaviors of residents in the short term. In the long term, the provision of stable housing would allow women to begin improving their physical, mental, and emotional health through programs like "Health on a Budget."

Comments from Mentors

“I first met Autumn Hackett in the fall of 2014; she was very excited and full of ideas for health promotion among vulnerable populations, in particular women experiencing homelessness. She was already in the process of designing the curriculum that would eventually become 'Health on a Budget,' the culmination of her honors project. Inspired by her experiences with the TCU Chancellor’s Leadership Program, she had established connections with the Center for Transforming Lives (formerly the YWCA shelter) in downtown Fort Worth. In addition, she had collaborated with nutrition students to strengthen the content of the curriculum. In short, she had created an interprofessional service-learning partnership!

I quickly realized that Autumn is a genuine servant-leader: insightful, humble, committed to excellence, open to feedback, and compassionate. Although I had served on honors committees in the past, I had not yet served as chair of an honors project when Autumn and I began working together. Equipped with the recommended deadlines of the Honors College, we drafted a reasonable timeline. Autumn wanted to work ahead, so she received institutional review board approval in the summer, well ahead of her anticipated workshop start date. A few months later, in the fall of 2015, she faced a setback: the Center for Transforming Lives was temporarily undergoing construction and would not be housing clients until the end of the year.

Instead of losing heart, Autumn made progress on initial thesis drafts and scheduled the 'Health on a Budget' workshop series during the week before classes started her final semester, the spring of 2016. As she implemented each session, she connected with participants and offered practical resources for the future as they transitioned to permanent housing and new employment. The participants expressed gratitude for the support to enhance their self-care and wellness without undue financial burden.

After finishing the 'Health on a Budget' workshop series, Autumn began data analysis and was able to complete her honors thesis while managing the final semester of nursing school and the job interview process. She worked ahead of deadlines, and she readily took on the challenge of the Boller Competition. Even though she expressed some self-doubt and anxiety beforehand, she presented her project with confidence, fielded questions with ease, and won the prestigious Harris College Boller Award and advanced to the university competition.

It was an honor to mentor Autumn throughout her honors project, and I was overjoyed that she earned significant accolades for her hard work and dedicated service. As a new chair, I was blessed by this mentorship experience and inspired to experience the creative synthesis of service with health promotion practice and research.”

--Dr. Gina Alexander


"It was a real pleasure to mentor Autumn as she worked to develop and test a program focused on improving the health of women experiencing homelessness. Her passion for the project and commitment to high standards were evident from start to finish. As faculty, it is a thrill to work with students of Autumn’s caliber and I know she will do great things after graduation!"

--Dr. James Petrovich

Article Details

Harris College of Nursing and Health Sciences