Table 1.

Adaptation of problematic items in the simplified Chinese version of the DISCERN instrument (C-DISCERN).

Category of adaptation	Problematic items in C-DISCERN marked through corresponding items in DISCERN	Before adaptation	After adaptation
Loyalty	4. Is it clear what sources of information were used to compile the publication (other than the author or producera)? 9. Does it describe how each treatment works? HINT: ...b	“other than the author or producer” was omitted or neglected. “each” was omitted or neglected.	“other than the author or producer” was retained. “each” was retained.
Expressiveness	1. Are the aims clear? HINT: Look for a clear indication at the beginning of the publication of: ... 7. Does it provide details of additional sources of support and information? HINT: Look for suggestions for further reading or for details of other organizations providing advice and information about the condition and treatment choices. 12. Does it describe what would happen if no treatment is used? 14. Is it clear that there may be more than one possible treatment choice? HINT: Suggestions of alternatives to consider or investigate further (including choices not fully described in the publication) before deciding whether to select or reject a particular treatment choice. ...	“a clear indication” was translated into “indicate.” “for details” was translated literally. “what would happen” and “used” were translated literally. “alternatives to consider or investigate further” was translated literally.	“a clear indication” was translated into “the content explicating the following questions.” “for details” was omitted. “what would happen” and “used” were translated into “consequence” and “adopt,” respectively. “alternatives to consider or investigate further” was translated into “other alternatives of treatment choices.”
Idiomatic expression	3. Is it relevant? HINT: Consider whether: the publication addresses the questions that readers might ask. recommendations and suggestions concerning treatment choices are realistic or appropriate. 4. Is it clear what sources of information were used to compile the publication (other than the author or producer)? HINT: Check whether the main claims or statements made about treatment choices are accompanied by a reference to the sources used as evidence, eg, a research study or expert opinion. ... 8. Does it refer to areas of uncertainty?	“Is it relevant?” was translated literally. “check,” “the main claims or statements made about,” and “as evidence” were translated literally. “areas” was translated into “places.”	“Is it relevant?” was replaced by “Does the publication address the questions that readers might ask?” “check” was omitted, “the main claims or statements made about” was translated into “in the text/publication,” and “as evidence” was translated into “evidently.” “areas” was translated into “factors.”
Readability and understandability	8. Does it refer to areas of uncertainty? HINT: Look for discussion of the gaps in knowledge or differences in expert opinion concerning treatment choices. Be wary if the publication implies that a treatment choice affects everyone in the same way, eg, 100% success rate with a particular treatment. 12. Does it describe what would happen if no treatment is used? HINT: Look for a description of the risks and benefits of postponing treatment, of watchful waiting (ie, monitoring how the condition progresses without treatment), or of permanently forgoing treatment.	“look for discussion of the gaps,” “affects everyone in the same way,” and “success rate” were translated literally. “watchful waiting” was translated into “watching and waiting,” and “permanently forgoing treatment” was translated literally.	“look for discussion of” was omitted, “the gaps” was translated into “lack,” “affects everyone in the same way” was translated into “applicable to all patients,” and “success rate” was translated into “100% effective.” “watchful waiting” was translated into “expecting treatment,” and “permanently forgoing treatment” was translated into “forgoing treatment” by omitting “permanently.”

^aItalicization indicates problematic parts of the items in C-DISCERN.

^bEllipses stand for the omitted parts of the items that are not problematic.