We searched the literature on H/UH mHealth programs on the databases PsycINFO, ProQuest, and EBSCO. Research terms were “H/UH youth,” “mHealth,” “mobile,” and “SMS.” We included papers dated 2010–2016 in order to highlight current trends. We categorized each paper into type of intervention: service utilization, HIV/STDs, and resource locator. We considered these three types to be essential aspects for prototype development and used them to help garner ideas for app design, look, and functionality. We then documented apps related to health, H/UH issues, and resource locators for prototype ideas. Lastly, we conducted expert interviews with providers in Santa Clara County. Based on information gathered from formative research, university students of Santa Clara University Frugal Innovation Hub developed a prototype of YTH StreetConnect, with the features outlined in Table 1.

We conducted think-aloud usability testing via the live app. Providers reviewed YTH StreetConnect PRO on a provided tablet, and H/UH youth reviewed YTH StreetConnect on a provided smartphone. We assessed the following questions and had participants use think-aloud usability methodology to openly state what they were doing, thinking, and feeling while using YTH StreetConnect [18]. We took notes on (1) user experience, (2) feasibility, and (3) needed changes.

After usability testing, we conducted a focus group with the same H/UH youth. The focus group was audio recorded, then transcribed with pseudonyms. Transcripts were read by 2 team members and coded through an emergent coding process, in which major themes arose from the data: app usefulness, changes needed, experience, and visuals. We considered these themes when creating the final prototype.

We recruited participants from H/UH services in the California Bay Area. We employed one H/UH youth to promote the project at shelters. Flyers were posted at shelters, at clinics, and on craigslist (San Francisco, CA, USA).

We screened potential participants via phone for eligibility. Youth eligibility criteria were age 18–25 years, reporting an H/UH situation, and being a resident of Santa Clara County. Table 2 lists the youth participants’ demographic characteristics. The provider eligibility criterion was providing H/UH youth services, including physicians, community center leaders, health providers, and housing directors. Youth participants received a US $100 gift card for the Safeway food retailer (US $50 for usability testing, US $50 for participating in a focus group) and providers received a US $50 gift card for participation.

Figure 2 shows the initial YTH StreetConnect PRO prototype.

Providers noted the simplicity of YTH StreetConnect and appreciated the clear images and text. Providers were able to intuitively access each function of YTH StreetConnect with little difficulty:

Overall, [YTH StreetConnect] is nice, clean, and easy to read.

This prototype is for a small catchment area and we cannot predict how a national database of services will function. Future work should engage with database specialists to determine the feasibility of scaling the service up to a national database. In addition, our small sample makes it difficult to capture more in-depth experiences and feedback.

We developed YTH StreetConnect and tested it with providers and H/UH youth. Because H/UH youth face challenges in service utilization, apps such as YTH StreetConnect may assist youth in finding and accessing services and improving continuity of care. YTH StreetConnect is a useful tool in streamlining services to H/UH youth online and can be especially useful as a supplement to in-person interactions between providers and youth. Future efforts could involve nonprofit agencies in conducting a national expansion of YTH StreetConnect and a pilot evaluation of its uptake among H/UH youth.