Objective-To develop a short instrument, called DISCERN, which will enable patients and information providers to judge the quality of written information about treatment choices. DISCERN will also facilitate the production of new, high quality, evidence-based consumer health information. Design-An expert panel, representing a range of expertise in consumer health information, generated criteria from a random sample of information for three medical conditions with varying degrees of evidence: myocardial infarction, endometriosis, and chronic fatigue syndrome. A draft instrument, based on this analysis, was tested by the panel on a random sample of new material for the same three conditions. The panel re-drafted the instrument to take account of the results of the test. The DISCERN instrument was finally tested by a national sample of 15 information providers and 13 self help group members on a random sample of leaflets from 19 major national self help organisations. Participants also completed an 8 item questionnaire concerning the face and content validity of the instrument. Results-Chance corrected agreement (weighted ) for the overall quality rating was =0.53 (95% CI =0.48 to =0.59) among the expert panel, =0.40 (95% CI =0.36 to =0.43) among information providers, and =0.23 (95% CI =0.19 to =0.27) among self help group members. Higher agreement levels were associated with experience of using the instrument and with professional knowledge of consumer health information. Levels of agreement varied across individual items on the instrument, reflecting the need for subjectivity in rating certain criteria. The trends in levels of agreement were similar among all groups. The final instrument consisted of 15 questions plus an overall quality rating. Responses to the questionnaire after the final testing revealed the instrument to have good face and content validity and to be generally applicable. Conclusions-DISCERN is a reliable and valid instrument for judging the quality of written consumer health information. While some subjectivity is required for rating certain criteria, the findings demonstrate that the instrument can be applied by experienced users and providers of health information to discriminate between publications of high and low quality. The instrument will also be of benefit to patients, though its use will be improved by training.

This study examined the application of DISCERN-validated criteria for judging the quality of printed information on treatment-to online health information in a workshop setting. A survey was conducted amongst 57 participants attending DISCERN Online workshops. Participants were health information users-health care and information providers, consumers (patients/carers), and consumer representatives. Workshops involved using DISCERN to appraise a health website. Participants completed questionnaires before and after the workshop, and at 2 months follow-up. Responses revealed that participants accessed online health information for professional (85.7%) and personal (75%) reasons. Less than half (41%) had applied some form of quality criteria to online information prior to attending the workshop. Despite varying levels of expertise, participants found DISCERN and the supporting materials accessible. The majority (96.2%) agreed DISCERN would help users discriminate between high- and low-quality online treatment information, and would be applicable to a wide variety of such information. At follow-up, most (89.6%) reported that their attitude to consumer health information of all types had changed-mostly becoming more critical or systematic. It is possible that general schemes such as DISCERN will provide users with simple and flexible skills for dealing with the wide range of treatment information available.

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In three experiments we investigated the effect on the performance of thirsty rats of varying the instrumental contingency between lever pressing and the delivery of a saccharin reinforcer. In Experiment 1, the subjects performed more slowly in a non-contingent condition, in which the momentary probability of reinforcement was unaffected by whether or not the animals pressed, than in a contingent condition in which the reinforcer was never presented except following a lever press. This was true of performance under both random ratio and interval schedules in which the function determining the probability of reinforcement following a lever press remained the same across the contingent and non-contingent conditions. Experiment 2 demonstrated that instrumental performance was less affected when the contingency was degraded by the introduction of free reinforcers if these reinforcers were signalled. In Experiment 3, lever pressing was reinstated to some degree after non-contingent training by giving non-reinforced exposure to the operant chamber in the absence of the lever. These results suggest that free reinforcers depress instrumental behaviour through a performance mechanism engaged by their ability to support conditioning of the contextual cues.