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.

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Increasing attention has been given over the last decade to the topic of health care information for patients and the public. This is called consumer health information and it encompasses information about health and illness at a lay level; information about health care services available from the statutory and voluntary sectors; and information about choices in treatment and care. This is not a uniquely modern phenomenon. A study of self care and early lay medical publishing shows a robust and continuing tradition of people looking after themselves, without recourse to health professionals and with advice from various vernacular sources. However it is only since the 1970s that libraries and information services have developed to provide ready access for the public to consumer health information. The first consumer health information (CHI) services were established in the United States. By the late 1970s the first uk services had been established in Stevenage and Southampton. For most of the 1980s these were the only well developed CHI services in the UK library world, with most health information reaching consumers through a variety of non‐library advice agencies. The last two or three years have seen a flowering of CHI services, with the encouragement of official policies on consumer choice and quality assurance. There have been advances in the bibliographic control of the subject with the availability of new CHI databases. This emerging information specialism is now reaching maturity with a new concern with quality of service.

Recently there has been increased emphasis on the user perspective in health care. At the same time the concern with effective health care is making us look more critically at the outcomes of treatment and other interventions, and the evidence available to us to make sense of effectiveness. This paper addresses the involvement of genitourinary medicine service users in outcome measurement through 3 linked questions: (1) What do we mean by outcomes? (2) What do we mean by users? and (3) What do we mean by involving?