A: Preparation of a list of questions.

At this stage, Carspecken recommends that when the researcher is interested in studying a specific group of people or a specific social place, or a social problem, he or she writes down his or her questions in a list using the brainstorming method. These questions should be general, comprehensive, and flexible; they can change at any stage of qualitative research [20]. Accordingly, in the present study, a list the questions intended by the researchers about the health-promoting lifestyle in women covered by comprehensive health service centers on the outskirts was written:

• How does a health-promoting lifestyle manifest itself in women covered by comprehensive health service centers in the periphery?
• What beliefs, values, and norms make the health-promoting lifestyle of marginalized women this way?
• How does a health-promoting lifestyle of marginalized women manifest itself in documents, manuscripts, records, and tools used in the comprehensive health service center?
• How does a health-promoting lifestyle of marginalized women manifest itself in home visits?
• How do cultural, political, social, economic, and historical structures influence the culture of a health-promoting lifestyle among marginalized women?
• How can the findings be explained and critiqued with relevant social theories?

B: Determination of the required information.

In the second preliminary stage, the researcher must specify in another list what information he needs to find the answers to his questions. Usually, this list includes the characteristics of social routines, the characteristics of specific documents, the rules of media products, and the characteristics of the actors who should be interviewed [19,20]. In the present study, the researcher has specified in another list what information he needs to find the answers to his questions, what social routines and specific documents he should observe, and who he should talk to and interview. Accordingly, the compiled list includes:

Social routines: creating an electronic health record in the system, providing services such as: education in the field of health promotion and disease prevention and self-care, doctor visits, screening individuals based on the service description (taking blood pressure, diagnosing diabetes using tests and a glucometer, diagnosing breast cancer using the examination method and screening colon cancer using the Faecal Immunochemical Test (FIT), etc.), referrals related to target diseases (communicable and non-communicable), nutritional counseling, psychological counseling, providing active services to the covered population (such as providing complementary services; such as vitamin D, iron tablets, etc.) and following up on people at risk (using health volunteers, sending text messages, calling and following up at home, etc.), daily activities, household chores, relationships with neighbors, ceremonies and celebrations, recreation and entertainment

Documents: Forms in the health records of the patients, registration books, signs installed on the walls, and written warnings by officials, and all cultural symbols and artifacts, such as how to dress, customs and traditions, entertainment and hobbies, how to prepare food and cook, etc.

Rules: Guidelines and all approved service packages

Actors: Physician, health care provider, midwife, and center nurse, environmental health, nutrition expert, psychologist, and women covered by the Comprehensive Health Services Center.

C: Researcher value orientation test.

According to Carspecken’s recommendation, at this stage, the researcher should be interviewed by a professional interviewer so that his/her biases and expectations are identified before entering the research field or compiling field notes and organizing the research questions [20]. For this purpose, in the present study, the researcher is qualitatively interviewed by a professional qualitative researcher before starting the fieldwork, then the audio file of this interview is transcribed, and the concepts contained in it are considered in all stages of collecting, analyzing, and writing.

Based on the Carspecken method, five main stages will be implemented in the following order.

The five main stages of Carspecken’s method are:

1. Compilation of primary records
2. Preliminary reconstructive analysis
3. Dialogical data generation
4. Description of system relations
5. System relations as explanations of findings

1. Compilation of primary records.

This stage involves conducting fieldwork to gather “first-hand experiences” from the cultural group or community being studied and to uncover their cultural patterns [20]. Fieldwork uses various data collection methods, such as observation and note-taking in the field, interviews and group discussions, and examination of documents and records. Observation in the field of ethnographic studies takes place in four forms: 1 – Complete observer, 2 – participant as observer, 3 – observer as participant, 4 – Complete participant [21]. In the first stage of research, Carspecken recommends that the researcher enter the field as a passive or inactive observer and provide initial documentation from an outside perspective. He believes that the information collected at this stage is monologue because the researcher speaks to himself alone when writing the documents and primary data. At this stage, the researcher does not engage the people under study in any dialogue and simply adopts a third-person position in relation to them and describes them from the point of view of a passive observer [20].

Carspecken has provided specific instructions for participant observation at the level of everyday interactions. For this purpose, Carspecken suggests the observation priority method. Accordingly, he recommends that you first choose one person in the field and record everything that person does and says accurately, then, in the second priority, record everything that another person who is interacting with the first person does and says, and in the third priority, write down everything that happens in the field. Then, every 5 minutes, choose a new person for this observation method. If an event occurs during this observation period that you find important, temporarily take your focus off the subjects so that you do not miss recording this event, but return to the observation priority program after the event is over [20]. To this end, the researcher attempts to describe the date and time, the dominant sense, the smell, the temperature and ventilation, the lighting and illumination of the research site during each participant observation period. Also, during the interactions, the participants’ facial expressions, movements, and body positions, and the tone of their voices are recorded in the form of short notes in the accompanying notebook. At the same time, the researcher’s personal prejudices and analyses will be recorded briefly in the accompanying notebook at an appropriate time. Then, at the end of each participant observation period, and immediately after returning from the research field, all field notes and journal notes will be entered in detail and in a Word file so that the details and sensory events of the interactions are not forgotten [20].

2. Preliminary reconstructive analysis.

This stage involves the initial and inductive analysis of unstructured data. In addition, it focuses on articulating and clarifying cultural and subjective elements, which are often implicit in nature. The analysis here is reconstructive and aims to articulate cultural themes and systemic factors that are usually not visible and not directly experienced by the participants involved in the communication.

This stage includes: low-level coding, initial meaning reconstruction, horizon analysis [20].

1. I. Low-level coding. This stage is done on primary records and requires minimal abstraction [22].
2. II. Initial meaning reconstruction: To reconstruct the initial meanings, the researcher must select multiple segments of the primary records simultaneously with the low-level coding. The selected components should represent behavioral patterns, reflect pattern anomalies, or reveal underlying norms of routine events. Next, the researcher has to copy these pieces into a separate Word file, read them line by line, and articulate the hidden meanings they think are the basis of the interaction by writing “meaning fields”. The meaning field is a range of possibilities, and the purpose of writing meaning fields is to use more words for the description of the observed actions in such a way that if the actor had tried to express all the meanings of the action verbally (not through vocal tone, posture, gesture, facial expression, timing, and prosodic forms), they would have used these sentences [20,23].
3. III. Horizon analysis: Horizon analysis is about the fact that we cannot comprehend ideas in the world without simultaneously understanding the horizon from which they arise. Analysis of the horizon gives us clues about what is socially acceptable in the situation under study and completes our perceptions of the cultural environment [24]. In the process of articulating validity claims in horizon analysis, subjective, objective, normative, value, and identity claims in meaningful acts are analyzed at the horizontal level. Carspecken argues that these claims are also pursued in a continuum from the highly foregrounded to the deeply backgrounded. In the process of horizon analysis, Carspecken calls this level of analysis vertical analysis. In this argument, he deals with cultural structures and their various layers. According to him, some cultural categories, beliefs, and themes are located in the surface layers of culture that people are aware of; nevertheless, culture also has deeper layers and structures. He considers vertical analysis a tool through which the researcher can identify the deep layers of culture [19].

According to Carspecken, the coding process should not be closed until the end of the third stage, because the third stage emphasizes conversational data and confirms the evidence from observations, so the interviews should also be coded [20]. In the present study, the coding process will be carried out according to Carspecken’s guidelines. First, low-level coding is carried out on the primary records, while simultaneously identifying meaningful segments and writing meaning fields for them using the obtained codes. Horizon analysis is then conducted for each of these meaning fields. From this analysis, high-level codes are reconstructed. In the next step, the primary records are re-examined to find codes or initial phrases corresponding to each high-level code, using horizon analysis. This process creates a hierarchical structure of low-level and high-level codes that can later be merged to form larger categories and create main categories [19,20,23].

3. Dialogical data generation.

In the third stage of critical ethnography using Carspecken’s method, interviews will be used to collect data. Carspecken believes that the ideal qualitative interview should be semi-structured and that the researcher should prepare an interview protocol that allows him or her maximum flexibility during the interview process [20]. The protocol introduced by Carspecken consists of four parts: the topic domain, lead-off questions, covert categories, and possible follow-up questions. The general scope of the interview topics is specified in the topic domain. Then, the lead-off questions are designed to open up these domains. Carspecken believes that the best lead-off question is one that asks about an event that the participant was a part of and the researcher witnessed, which should be very concrete and clear and not abstract. Then, as the participant describes the event, the researcher attempts to elicit, with appropriate questions, the underlying beliefs, values, beliefs, and feelings involved in that event. Carspecken recommends that for each topic area, a list of items that the researcher would like the participant to mention during the interview, but does not want to ask about explicitly, be written down. These are called covert categories. In this way, the researcher organizes these items in his or her mind so that he or she can refer to them during the interview and not forget anything important. Therefore, when a topic domain opens up, the interviewer must skillfully guide the participant’s conversation through the lead-off questions. Finally, the researcher should write down possible follow-up questions for each topic area. Carspecken recommends that in cases where the interview is very far from the time of observation or the researcher wishes to simply interview a participant, it is better to ask questions about events that occur routinely in the context [20]. During participant observation, the researcher may need to interview or talk to participants to answer his or her questions and interpret what he or she has observed. In fact, interviews are used to clarify, validate observations, and guide further observation [19].

Accordingly, in the present study, interviews and conversations about observed events and interactions will be conducted by the researcher to uncover the meanings, beliefs, values, and convictions that underlie behavior. In addition, interviews will be conducted using an interview guide suggested by Carspecken to help answer the research questions. Interviews will be conducted in-depth, with due regard for psychological safety, privacy, and confidentiality of information, and will be recorded with the consent of the participants. The time and place of the interview will be determined by the participants themselves. Accordingly, in the present study, the researcher attempts to collect appropriate conversational data during participatory observation and, if necessary, uses interviews to complete concepts and questions. To this end, the researcher develops an interview protocol based on the proposed protocol of Carspecken for conducting formal interviews with key informants, revises it based on the opinions of experts, and then uses it in formal interviews. For example:

Topic domain: Health-promoting lifestyle.

Lead-off question: How do you evaluate your health status? What do you do to maintain your health? What factors can help improve your health? What makes you do or not do behaviors that increase your health? Please tell us about the health-promoting behaviors you have experienced.

Covert categories:

1. - Belief: What do you think about this? What makes you think this way?
2. - Acceptance and belief: Do you accept or not accept it?
3. - Feeling: How did you feel?
4. - Values: Why should it be this way or not?
5. - Expectations: What do you expect?

Possible follow-up questions:

1. - What do you mean? Please explain more.
2. - Can you give an example?
3. - What else do you remember about this?

Furthermore, Carspecken suggests that documents should also be reviewed in the study [20]. In the present study, the documents and records available in the Comprehensive Health Services Center, various documents and records related to the research questions, including minutes, policies, guidelines, health care provider reports, educational materials (brochures, pamphlets, conferences), and all cultural symbols in the women’s living areas, such as; how to dress, customs and traditions, recreation and entertainment, how to prepare food and cook, etc., will be reviewed to find examples of health-promoting lifestyle culture.

4. Description of system relations.

The purpose of the fourth stage of Carspecken’s method is to describe the relationship of the system with a broader context. The researcher determines the integrity of the system by testing several sites related to the study site and experiencing the cultural reconstructions already developed. The researcher asks about the origin of the emerging cultural themes, and the answer to this question will lead them to related places and situations. Accordingly, to analyze social structures, existing inequalities, injustices, and cultural ideologies based on the principles of critical theory [19], the researcher can ask the following questions:

1. Why did these particular cultural themes emerge? This question is usually answered through historical considerations and the study of the socio-economic and political environments in which people live and work.
2. How do cultural forms acquired in one social site relate to other cultural forms in other social sites? This question is answered through searching other social sites that are frequently referenced and repeated by study participants [20]. In addition, media and other cultural goods are important factors to consider [19], because a particular cultural product can influence the relationships and discourse within the study site and therefore needs to be analyzed carefully [20].
3. What functions do the consequences of action fostered by cultural forms serve in larger social networks? In this area, class and gender reproductions have often been emphasized by critical researchers [19].

In the present study, the proposed guidelines for analyzing systemic relations, as explained above, will be used. Accordingly, in the first stage of systemic relations, the findings of the present study are presented within the framework of analyzing historical, social, economic, and political structures. Then, in the second stage, the cultural forms obtained in the current research field are compared with the cultural forms of other social places, and the impact of media and cultural goods on the concepts obtained from the research field is examined and critiqued. In the final stage, the impact of the consequences of the actions and cultural forms produced in the research field on larger social networks is addressed.

5. System relations as an explanation for the findings.

In the fifth stage of Carspecken’s method, the findings are analyzed and interpreted in the light of general social theories to explain what has been discovered in stages 1–4 with the help of these theories. Moreover, at this stage, the macro-sociological theories are challenged, changed, or modified [19,23].