iPoorly: Giving parents the tools to care with confidence
Associate Professor Dr Matthew Carey and Professor Damian Roland
Children’s emergency departments, urgent care centres, and GP practices across the UK are seeing millions of young children under five with acute illness every year, up 42% in the past 10 years. Knowing whether to treat a child with acute illness at home or access healthcare services presents uncertainty and anxiety for many parents.
Drawing on more than a decade of research into safety netting and family needs through the Ask Sniff programme, our team of clinicians and researchers at the University of Plymouth has developed iPoorly. An educational app that supports parents and caregivers of children under five years with acute illness, when they’re unsure which service to access, or how to treat a child at home.
iPoorly gives parents access to specific information about their child's condition, drawn from a validated evidence base built over years of research and patient and public involvement (PPI), in a format they actually find useful (rather than turning to a Google search, which can be unreliable). The tool isn't diagnostic and doesn't replace clinical advice. It's designed to ensure parents and caregivers have the knowledge to make informed decisions about the care their child needs.
iPoorly in app format was released for testing on Android and iOS app stores for six weeks. The app was downloaded 603 times and was the first of its kind to be validated by parents via an embedded evaluation form.
Optimising iPoorly with Cisco and The Lister Alliance
With the core iPoorly app established, we worked with Cisco through The Lister Alliance programme to explore how to optimise iPoorly, making it more user-friendly and functional for parents and caregivers, especially those feeling panicked or under pressure.
Our partnership revealed a clear opportunity to deliver this validated advice in a conversational way, so we explored integrating an AI chatbot into the tool to respond to natural questions and provide guidance in an accessible way. Before deploying and testing an AI chatbot in such a critical use case, we decided to evaluate the effectiveness of this communication mechanism as a post-consultation intervention — helping parents after they’ve engaged with a clinician when traditional safety netting would be in place.
Post-consultation safety netting
Post-consultation safety netting involves a clinician explaining what to expect over the coming days, how an illness is likely to progress, what's normal, and crucially, what isn't. Done well, it gives caregivers the knowledge to manage their child’s illness confidently at home.
However, gaps in communication can have serious consequences. Children’s conditions can worsen without prompt action because the advice parents were given wasn't understood, wasn't in an accessible format they could use, or wasn't given at all.
Throughout the Ask Sniff project, we built up a significant evidence base around this “communication discordance”, including a systematic review and extensive work with parents and caregivers directly. This PPI forms the foundation of iPoorly.
The importance of co-creation with caregivers
Ethnicity, cultural background, language barriers, the child’s age, ongoing conditions, and previous experience with healthcare services all shape how a family needs to receive information. A one-size-fits-all approach to safety netting will inevitably fall short for a significant portion of the population.
To ensure iPoorly serves the people it’s designed to help, we’re leading a systematic review focused on underrepresented communities, looking at where parents go for health information, and how reliable that information is. We found that while some tools like this exist, meaningful parental involvement in their development is limited or unclear. With iPoorly, PPI has been embedded from the beginning.
Early AI testing has already told us that the digital delivery of a large number of questions can be overwhelming. In a face-to-face consultation, the clinician can respond to cues and adjust their approach. AI chatbots aren’t that intuitive (yet), so we’re actively working to get the balance right.
What’s next for iPoorly?
We’re now running a feasibility pilot, using iPoorly’s evidence base in the post-consultation context with GP practices who want to test the service. The pilot tests two goals. First and foremost, patient safety, ensuring children’s conditions don’t worsen due to communication gaps post-consultation.
Second is reducing system pressure. Caregivers may return seeking reassurance for concerns which don’t need a face-to-face review or anxiety over symptoms which aren’t serious. By reducing volumes of children presenting to general practices and emergency departments, we allow better care and better patient experiences for those who do attend.
Ultimately, if iPoorly can give families genuine confidence to manage situations at home safely, we can reduce harm to children and unnecessary re-presentation to services, and ease pressure on the healthcare system.
In this next phase, we’ll continue to refine iPoorly’s usability and accessibility using parent and caregiver feedback, ensuring the tool is as valuable and impactful as possible. We hope iPoorly will become a standard part of the post-consultation journey accessible through the app, and potentially services like NHS 111, supporting the needs of children, caregivers, and the healthcare system throughout the country.