Awareness, Experiences, and Attitudes Toward Preprints Among Medical Academics: Convergent Mixed Methods Study.

Background: Preprints-scientific manuscripts shared publicly prior to formal peer review-are gaining momentum across academic disciplines. However, their adoption in clinical and biomedical sciences remains limited, particularly in countries where traditional publishing norms prevail. Editorial ambiguity and a lack of national policy further complicate their use. Objective: This study aimed to assess the awareness, experiences, and attitudes of medical academics at Marmara University School of Medicine toward preprints and to explore the editorial landscape through both journal editor feedback and a review of journal-level preprint policies. Methods: A cross-sectional survey was conducted with 103 medical faculty members. The questionnaire included demographic questions, Likert scale items, and multiple-choice items assessing knowledge, familiarity, and attitudes toward preprints, as well as open-ended items to explore concerns. A "preprint test score" (0-4) was developed to quantify objective knowledge. Subgroup analyses were conducted by age (<40 vs ≥40 y) and academic discipline (basic vs clinical sciences). Additionally, all responses to open-ended questions from journal editors and 118 biomedical journals were manually reviewed for their stated stance on preprints and article processing charges (APCs). A convergent mixed methods design was used, combining a structured survey, thematic analysis of open-ended responses and editorial feedback, and a document-based review of biomedical journal policies. Results: Only 42.9% (n=34) of participants reported familiarity with the concept of preprints, and 13% (n=10) had previously published on a preprint server. Misconceptions about ethics, peer review, and compatibility with journal policies were common. Subgroup analysis revealed that older participants scored higher on the "preprint test" (mean 2.20, SD 1.31 vs mean 1.97, SD 1.60) and had more experience with preprint publishing (1/40, 2.5% of younger participants; 7/29, 24.1% of older participants). Further, younger academics expressed less openness toward future use (n=7, 17.5% in the younger group; n=8, 27.6% in the older group). Clinical faculty were generally more hesitant than basic science faculty, although both groups raised concerns about the academic recognition of preprints. Editorial responses reflected a mix of cautious endorsement and skepticism. Among the 118 biomedical journals reviewed, most lacked clear preprint policies, while a small number either explicitly prohibited or permitted them. Conclusions: There is limited awareness and cautious engagement with preprints among medical academics and editors in Türkiye. Generational and discipline-based differences further influence knowledge and attitudes. The lack of clear editorial guidance from biomedical journals may reinforce academic uncertainty. Tailored educational initiatives, transparent journal policies, and institutional support will be essential to foster a more open and inclusive scientific publishing environment.