Cluster randomized trial of an active, multifaceted information dissemination intervention based on The WHO Reproductive health library to change obstetric practices: methods and design issues [ISRCTN14055385]

A cluster randomized trial to improve obstetric practices in 40 hospitals in Mexico and Thailand is conducted. The trial uses a stratified random allocation based on country, size and type of hospitals. The core intervention consists of three interactive workshops delivered over a period of six months. The main outcome measures are changes in clinical practices that are recommended in RHL measured approximately a year after the first workshop.The design and implementation of a complex intervention using a cluster randomized trial design are presented.Designing the intervention, choosing outcome variables and implementing the protocol in two diverse settings has been a time-consuming and challenging process. We hope that sharing this experience will help others planning similar projects and improve our ability to implement change.There is an increasing recognition of the information access and management problems of health care workers. [1] Resolving a clinical problem begins with a search for a valid systematic review or practice guideline as the most efficient method of deciding on the best patient care. [2] Systematic reviews of randomized controlled trials are widely acknowledged as providing the gold standard evidence base to support decision-making for further research, policy and practice. Systematic reviews prepared by the Cochrane Collaboration are published electronically and have the additional advantage of being updated, as new evidence becomes available.The World Health Organization has published The WHO Reproductive Health Library (RHL) since 1997 in an effort to provide access to the most reliable and up-to-date information to health care workers in developing countries. [3] This annually updated database includes predominantly Cochrane systematic reviews that are relevant to reproductive health problems faced in low-income countries together with commentaries written by experts familiar with under-resourced settings, short practical guidance documents