Angélique Roy,
Health Sciences Librarian, Bracken Health Sciences Library,
Queen’s University, Kingston, ON, Canada
Brendan F.R. Edwards
Curator, W.D. Jordan Rare Books and Special Collections,
Queen’s University, Kingston, ON, Canada
Abstract
While student stress and anxiety have long been recognized as challenges in higher education, libraries have increasingly adapted their roles by integrating playful activities throughout the academic year to actively support student mental well-being. The Ol’ Medical Colouring Book was designed with health sciences and history students in mind to serve as a de-stressor activity during the exam period and features images from antiquarian anatomy and botany texts found within the library’s collection. It was created by a second-year History student as part of an experiential learning internship, co-supervised by two librarians. The initiative included two three-hour pop-up events where the historical texts were displayed for students to browse and discuss the history and provenance of the works alongside the colouring book. The librarians then sought an ISBN for the book acknowledging the work of the intern and a copy was deposited in Library and Archives Canada as well as the university’s institutional repository. The Ol’ Medical Colouring Book was received with enthusiasm by students and faculty alike, and remains a popular activity during the busy exam season. This article explores the intersection of student mental health initiatives, rare and special library collections, and the use of play-based activities to promote wellness and fun within the academic library setting.
Introduction
Educational climate
Higher education has become marked by escalating academic pressures that profoundly impact the mental health and well-being of students. As educational institutions demand higher academic achievement and more extracurricular involvement, students find themselves navigating an intensely competitive environment that has consequently resulted in unprecedented levels of stress and anxiety. Societal factors beyond academics such as politics, environmental concerns and market instability along with social media influences and career uncertainty has increased the number of students reporting psychological distress (Cox & Brewster, 2021). Beyond the common pressures related to grades and finances, students are growing increasingly concerned about the world around them, compounding the stress they experience during their studies.
Student Stress and Anxiety
Stress and anxiety experienced by students is not a new phenomenon (Andrews & Wilding, 2004; Chernomas & Shapiro, 2013; Misra & McKean, 2000; Regehr et al., 2013), but the Covid-19 pandemic exacerbated feelings of isolation and disconnectedness as colleges and universities were forced to transition to online learning. This disruption to on-campus life introduced myriad challenges for students caused by increased screen time, technical connectivity issues, distractions and exhaustion. Boundaries between the professional and personal were blurred in this new learning environment making it difficult to adjust. A study by Appleby et al. (2022) found that 78.9% of students surveyed (n = 3013) felt concerns about the long-term impact the pandemic would have on their academic and job prospects, and 58.4% reported a negative impact on hobbies and leisure activities. Changes to academic schedules and milestones, financial strain, and isolation from peer and family support networks had a significant impact on mental health and well-being. The results of the American College Health Association-National College Health Assessment (ACHA-NCHA) Canadian Reference Group Data Report Spring 2022 indicates that under 30% of students surveyed (n = 11, 322) spent time engaging in meditative activities each week. In keeping with other findings, 43% reported a negative impact on academic performance and degree progression caused by stress (American College Health Association, 2022). A systematic review and meta-analysis published in 2013 found that almost half of the student body reported significant stress levels in the form of anxiety or depression resulting in lower engagement with their studies and their peers, but that interventions focused on mindfulness, among other types, significantly reduced symptoms (Regehr et al.).
Role of the library in supporting student wellness
As these concerns persist in the post-pandemic environment, academic libraries play an important role in providing creative activities and services to help mitigate stress and anxiety (Bladek, 2021; Rose et al., 2015). While libraries have always supported research and learning, they are well-positioned to support student wellness. Serving as a central hub where students congregate for independent and collaborative study, considerable time is spent within these physical spaces on campus. Operational hours include evenings and weekends recognizing the diverse schedules and needs of its users, and library staff are available to help with queries ranging from loaning adapters and chargers to guiding students through complex database searches (Nance, 2022). While many resources are now available online, many students continue to work and study in library spaces for their facilities and the sense of community they provide.
As part of broader campus-wide wellness initiatives, library services have evolved to adopt student support as an integral extension of their core mission. This perspective is particularly evident during times of high stress such as mid-terms and exams, where libraries transform into more than just research spaces. Strategic wellness programming introduces deliberate opportunities for student relaxation and mental recovery. During these intense academic periods, libraries offer micro-break activities designed as a reprieve from academic responsibilities. Micro-breaks are defined as being only a few minutes in length with the intention of shifting focus away from the task at hand as part of a mindful disconnect which helps to increase productivity and reduce fatigue (Nance, 2022; Rose et al., 2016). Common stress-relief activities can include puzzles, board games, Lego building, colouring, drawing, and leisure reading. A survey of academic libraries in the United Kingdom examining how student mental health was being addressed before and during the pandemic found that study break activities like craft classes were prevalent across institutions. Approximately half of the respondents reported that their library’s mental health initiatives were developed in alignment with broader university strategies, while a quarter indicated that well-being programs were a direct response to student-expressed needs and concerns (Cox & Brewster, 2020). By strategically and intentionally offering play and relaxation activities, libraries acknowledge the role of mental health in academic success.
Adult colouring
While colouring books thrived in the mid-2010s across disciplines and markets, a search for ‘adult colouring book’ on Amazon today yields over 90,000 results. The trend began in earnest in 2013 when a colouring book by Scottish illustrator, Johanna Basford, was published for adults despite having been asked to draw one for children. Two years after its release, over two million copies had been sold (Raphel, 2015). In 2015, BookNet Canada, a non-profit dedicated to developing standards and education for the Canadian book market, reported a 5.5% increase in non-fiction sales, largely owing to the rising popularity of adult colouring books within the Games and Art categories (BookNet Canada, 2016). When polled about their motivations for purchasing a colouring book, almost 70% of adults indicated the activity was chosen as a method for relaxing or unwinding (BookNet Canada, 2015).
Despite concerns expressed by psychologists at the time who did not view the activity as providing therapeutic benefits, instead describing it as restrictive, promoting mindlessness, lacking creativity, and hardly qualifying as play (Ashlock, 2015; Raphel, 2015), adults gravitated to these books for stress relief and a means for reducing screen time (Blackburn & Chamley, 2016). The movement gained momentum over social media as avid colourers and even celebrities took to Facebook and Pinterest to share their creations (Blackburn & Chamley, 2016). In February 2016, the New York Academy of Medicine Library launched its first annual #ColorOurCollections social media campaign. Each year, libraries, museums, galleries and other cultural institutions are asked to share colouring pages of their collections for users to decorate and repost on their own social media accounts using the campaign’s hashtag. This weeklong event transpired from an informal Twitter conversation with the goal of making participation as simple as possible, allowing individual institutions to determine the depth and range of submissions (Garner et al., 2017). Today, the campaign remains popular with almost 100 institutions participating annually.
Mindful colouring
Over the past decade, various academic libraries across Canada and the United States have hosted colouring events to help combat stress and anxiety faced by students. Between 2015-2016, librarians at the Criss Library at the University of Nebraska Omaha held three full day “Color Me Calm” events to coincide with exam periods. Sharpies and gel pens were provided along with copyright-free colouring pages sourced from Pinterest for students to enjoy. These events saw over 200 participants, and many indicated feeling happier when they left as they had been when they arrived (Blackburn & Chamley, 2016). During this same timeframe, Libraries and Cultural Resources at the University of Calgary hosted a series of play-based events in conjunction with the release of a mental health strategic plan which included adult and children’s colouring pages supplied by the law library, as well as a colouring book of items from within the special collections library (Clarke & Morrow, 2016). These activities served the twofold purpose of infusing mindfulness activities into library spaces and to align with the strategic priorities of student well-being within the institution. In 2017, five years prior to the creation of the Ol’ Medical Colouring Book, a similar initiative was undertaken by staff at the University of Alberta. A practicum student created colouring pages from images found within rare books from the health sciences collection using the MyPaint program. The goal of these pages was to provide students with a fun study-break activity while also engaging in special collections outreach (Hamonic & Dennett, 2017). Around the same time, a librarian at the University of Massachusetts was inspired by unique and ‘quirky’ historic patent images and created a series of colouring books dedicated to them to engage in discussions about patents and innovation. This process was converted into a group exercise on two separate occasions with colleagues and students where they searched for and selected patents for inclusion in a colouring book (Borrego, 2020).
More recently, studies have determined that structured colouring through consistent engagement or through colouring mandalas significantly reduces stress and anxiety making it an effective mindfulness activity (Duong et al., 2018; Palmer-Cooper et al., 2019). Further, two randomized controlled trials within medical settings reported a reduction in pain and anxiety for patients receiving or awaiting care (Rajendran et al., 2020; Sadeqi et al., 2024). Colouring is a powerful wellness activity that spans setting, demographics, and experience.
Objectives
Recognizing the state of student mental health and the positive impact of colouring on well-being, librarians at the Bracken Health Sciences Library and the W.D. Jordan Rare Books and Special Collections at Queen’s University in Kingston, Canada partnered on an outreach initiative harnessing historical medical texts in the collection for creative stress relief during the exam season. The Ol’ Medical Colouring Book is the result of a 12-week undergraduate practicum course co-supervised by the librarians. This paper describes the process, impact, and results of this outreach effort which sought to encourage play while showcasing library resources to support student wellness and alleviate exam stress. It describes the creation process, the final published print and digital product, and provides recommendations for those seeking to undertake similar projects within their institutions.
Initiative Description
Setting
Queen’s University Library (QUL) comprises six physical service points across campus, supporting the university’s vision as a Canadian research-intensive institution with a transformative student learning experience. With collections that have been developed since the University’s founding in 1841, today QUL is a member of consortia and associations including the Canadian Association of Research Libraries (CARL), the Ontario Council of University Libraries (OCUL), the Canadian Research Knowledge Network (CRKN), the Association of Research Libraries (ARL), and the Center for Research Libraries (CRL). Well-being is one of the University’s five core values for its community of over 31,000 undergraduate and graduate students across six faculties.
The Bracken Health Sciences Library provides information services and resources including knowledge synthesis support to students, faculty and researchers across the Health Sciences, as well as technology-rich spaces for collaboration and study. The W.D. Jordan Rare Books and Special Collections, located within Douglas Library, is a research and teaching resource for students, faculty, and the larger university community, preserving and providing access to a variety of materials including rare books, maps, posters, and a significant Canadiana collection.
Getting the colouring book off the ground
The Ol’ Medical Colouring Book was initially envisioned by a Health Sciences Librarian and the Rare Books Curator at Queen’s University in the summer of 2022, having both started in their roles less than two years prior. They were inspired by Ohio State University’s A Vesalius Colouring Book (Ohio State University Health Sciences Library, 2019) which was featured in the 2019 #ColorOurCollections social media campaign hosted by the New York Academy of Medicine Library. With this event and an exemplary submission in mind, the librarians loosely brainstormed the contents for a colouring book that would highlight rare medical texts across the 16th and 18th centuries within the W.D. Jordan’s collections including Vesalius’ De humani corporis fabrica to focus on human anatomy works, as well as many others. The core purpose was to create a colouring book for the Fall exam season to serve as a vehicle for stress relief and play while presenting students with select materials they may not otherwise have exposure to throughout their studies. The primary intended audience was students studying health sciences or history.
Project Description
With numerous benefits in mind and the potential to participate in #ColorOurCollections, the idea for the Ol’ Medical Colouring Book was formed. While proceeding with enthusiasm and excitement, the biggest concern was limited time resources given the approaching Fall semester which would mean increasingly demanding schedules preparing for the return to class and campus. It was during this initial brainstorming process that the opportunity arose to co-supervise a student enrolled in an experiential learning course focused on historical practice due to the rare books curator’s previous participation in the program. The experiential learning courses seek to expose undergraduate students to a broad range of professional activities across galleries, libraries, archives and museums (GLAMs), as well as providing opportunities to learn more about publishing, communications and policy writing. During these internships, students gain practical experience and hone the skills and knowledge gained throughout their studies in History. Co-supervision allows students to benefit from the combined knowledge and resources of multiple supervisors while modelling the teamwork and communication skills essential in many professional settings. The Queen’s Library medical colouring book project was submitted as an option that students enrolled in the internship course could select and in September 2022, a second-year History student intern began working with our team on the initiative. This internship and the decision to jointly supervise the intern made it possible to complete the colouring book within the target timeline of three months to coincide with the beginning of the December 2022 exam season.
Planning, process and logistics
While the target audience was health sciences and history students, namely undergraduate and graduate students, the hope was that students from across all faculties would take interest in the colouring book as a means of practicing self-care before exams or simply out of a curiosity for the historical collections presented within. With this goal in mind, the intern proposed expanding the contents to also include images from historical biology texts with a focus on botany given the popularity of floral prints. They selected all images from five historical texts in the W.D. Jordan collection that are in the public domain: Andrea Vesalius’ De humani corporis fabrica libri septem (1555), John Browne & Sir Charles Scarburgh’s Myographia nova sive musculorum omnium (1687), Thomas Willis’ Cerebri anatome: cui accessit nervorum descriptio et usus (1664) and Elizabeth Blackwell’s Herbarium Blackwellianum emendatum et auctum, id est, Elisabethae Blackwell Collectio stirpium (1765). Illustrations were photographed using an iPhone and the colouring book-quality images were created using the Photoleap photo editor app to remove backgrounds.
Fig. 1: Image of a skull from Vesalius’ De humani corpus fabrica libri septem next to the final colouring book illustration
The images were selected based on their recognizability and the ease with which they could be coloured using various artistic and digital tools. During the process of reviewing images, the intern developed short tips on ways to support your mental health during this stressful time of year to accompany the anatomy images. These pages also include a description and a reference to the rare book from which it was retrieved.
Fig. 2: Ways to support your mental health tip with anatomical illustration description
Medicinal properties were featured on pages opposite of the plant images which were retrieved from two editions of Nicolas Culpeper’s The Complete Herbal where available or RxList.
Fig. 3: Botany image and description pages
The student wrote the Welcome page for the colouring book to provide insight into the objective, the accessibility of the sources, and to acknowledge the particular focus as “the images in this colouring book originate from books printed in Europe in the 16th, 17th and 18th centuries. The images reflect the cultural and scientific perspectives of this time and place” (Kane et al., 2022).
Fig. 4: Ol’ Medical Colouring Book Welcome page
One such consideration was the underrepresentation of sex differences between male and female human anatomy during the 16th and 17th centuries. The first accurate depiction of the female skeleton is credited to Samuel Thomas von Soemmerring in 1796 (Schiebinger, 1986). The intern located only one image of the female form from the Vesalius text which was paired with a singular image of the male form.
Fig. 5: Page with illustration of urinary system shown on the female form
The cover page image was taken from Willis’ Cerebri anatome while the bookplate was designed by the intern from inspiration received throughout the process of examining the historical texts.
Figure 6: Cover of the Ol’ Medical Colouring Book
Fig. 7: Front bookplate
A page was included at the end of the colouring book where students could colour and create their own bookmark of male and female figures from the anatomy section.
Fig. 8: Colour your own bookmark page
All work was conducted in person at the W.D. Jordan Library over the course of approximately ten hours per week. The entirety of the colouring book was designed and created in the free version of Canva. It was endorsed by Student Wellness Services (SWS) and a brief description of the service is included towards the back of the book with QR codes linking to the website as well as the websites of the W.D. Jordan Library, the Bracken Library, and Queen’s University Library. It was printed using the services of the Queen’s Print & Copy Centre which was chosen as a campus partner that focuses on environmentally conscious printing practices. Printing was, and continues to be, funded by the Office of the Provost and Vice-Principal (Academic) through support from the Associate University Librarians and University Librarian.
Prior to its first print run, the rare books curator sought an ISBN from Library and Archives Canada for the Ol’ Medical Colouring Book to credit the work of the intern (Kane et al., 2022a) and a second ISBN was acquired for the digital version which is available to download from QSpace (Kane et al., 2022b), the open access repository for Queen’s University scholarship and research. Two copies were deposited with Library and Archives Canada and the colouring book is discoverable on WorldCat. An accompanying virtual exhibit was created using Omeka with links to the library record of some of the represented texts and to the eBook edition. It is also a featured exhibit of the Queen’s Library Rare Books Collection and linked in the library’s Human Anatomy LibGuide.
Pop-up events
During the initial brainstorming discussion, the necessity of incorporating a strategic outreach component into the colouring book project was identified. This was envisioned to serve a dual purpose: firstly, to promote the use of the colouring book as a playful, stress-reducing activity and secondly, to foster deeper engagement among the student body with the historical subject matter and artifacts featured. Two three-hour pop-up events were held early in the exam period where the librarians distributed printed copies of the Ol’ Medical Colouring Book and had three of the four original texts on display for browsing. A unique hashtag was developed by the intern and another Bracken Library staff member, a play on Queen’s University and the medical content, to draw attention to the event and the colouring book: #colourmeQUred. Bright yellow stickers with “Share what you’ve coloured! #colourmeQUred” were added to each copy and posts were shared on the Queen’s University Library and W.D. Jordan Library Instagram accounts.
Fig 9: Instagram post sharing the ColourmeQUred hashtag
Signage advertising the event was created in Canva and shared across social media, the library website, the Queen’s Gazette (the University’s newspaper of record), and sent directly to various departments and faculty members to promote the pop-ups. The goal of these two events was to encourage students to interact with the antiquarian materials and ask questions about the books, the images featured in the colouring book or about the project itself. The intention was to create an immersive experience that would not only captivate the students’ interest but also deepen their understanding and appreciation of the historical context the images in the coloring book represented. During conversations between the librarians and students at the pop-up events, students were encouraged to share their coloured images or their thoughts on the historical objects on social media using the hashtag.
The first pop-up was held during the two-day study break between classes and the start of the exam period. The event was hosted in the lobby of the main health sciences building at Queen’s within which the Bracken Library is also located. It was met with great enthusiasm from health sciences students.
Fig. 10: Librarians outside the Bracken Health Sciences Library hosting the first of two pop-up events
The initial print run included 200 copies of the colouring book, and a small packet of crayons was distributed with each. The colouring books were distributed in their entirety within two hours of the first pop-up. This necessitated another print run to be available for the second pop-up which took place one week later at the central library site. An additional 400 copies were printed which were to also be distributed with crayons. The second event was not considered quite as successful, with 150 colouring books distributed during the three-hour timeframe. The outstanding 250 copies were divided between the Bracken Library and the W.D. Jordan Library and were quickly collected by students during the remainder of the exam period. While the library’s Communications Coordinator assisted with subsequent print runs of the Ol’ Medical Colouring Book, the initial development of promotional materials and communications were executed by the librarians, library staff and the intern.
#ColorOurCollections 2023
A driving factor for the project was to participate in the 2023 New York Academy of Medicine Library’s Colour Our Collections campaign. This was the first time the Queen’s University Library participated in the event which took place during the first week of February.
Outcomes
As the colouring book project was undertaken over the span of a single semester, the focus was on its design and creation. No formal evaluation plan was implemented, but engagement with the colouring book and the rare books collections were measured through the distribution of the book, the interactions during both pop-up events, and positive student feedback. Between the two pop-up events and the duration of the exam period, 600 copies of the colouring book were distributed to students and faculty. Between the end of the official event in December 2022 and Spring 2024, two orders were placed totalling over 500 additional copies and were distributed during Winter and Spring exam periods. While both pop-ups were successful, certain factors may have resulted in the first being better attended than the second. Coincidentally, an anatomy exam was taking place the same afternoon as the event held outside of the Bracken Library. The colouring book was not promoted as an educational tool, yet students were keen to take one considering the upcoming exam.
The decision to hold the event within the health sciences building lobby was made to increase potential foot traffic and prevent disruption to those studying inside the library and seemed to positively impact engagement with students and faculty as almost all who were passing stopped to grab a colouring book or discuss the items on display. It was believed that the second event at the central library would yield greater traffic due to its size, but the timing of this event being one week after the first meant that exams were actively taking place across all departments, decreasing the frequency of visitors coming in and out of the library. While fewer colouring books were distributed during a longer timeframe at this pop-up, many students and faculty stopped to learn more about the medical texts on display and collect a colouring book and crayons.
The hashtag was used in a series of Instagram posts about the Ol’ Medical Colouring Book leading up to the event and subsequently to celebrate the #ColorOurCollections event but was not adopted by any event attendees or by students that retrieved a copy. While the print and digital versions of the colouring book are discoverable using the Queen’s Library website due to their unique ISBNs, no circulation statistics are available for the print copy given its status as a non-circulating print item. The digital copy deposited in QSpace does allow for tracking the number of downloads. From the launch of the colouring book to late-2024, it has been viewed almost 300 times and downloaded 79 times. Formal evaluation of the colouring book was initially discussed but was not fully developed for the December 2022 launch. While there is no formal or statistical data to support that the colouring book was effective at relieving stress, observational evidence suggests that it continues to be enjoyed by students and faculty alike.
Other opportunities arose to share the colouring book, marking its impact at Queen’s and beyond. During the initial launch, the librarians were approached by the University Secretariat and Legal Counsel to circulate a copy intended to showcase student initiatives on campus to the Board of Trustees and the Senate. The intern also delivered a presentation on the process and experience of creating the colouring book at the annual Inquiry @ Queen’s Undergraduate Research Conference (Kane, 2023). Librarians at other institutions who became aware of the initiative and were hoping to do similar play-based activities for students have also since reached out. Additionally, copies were also requested to be included in a creativity zone at a national health sciences libraries conference in 2024 for attendees to experience.
Lessons learned
To time the launch of the colouring book with the start of the Fall exam season, no formal evaluation plan was conceived resulting in the absence of a prescribed method for measuring impact and reach. Qualitative approaches such as a questionnaire and social media engagement were considered but not formalized. As the intern worked continuously on collating images and tips for inclusion, there was also no time for a social media sprint to promote the colouring book and pop-up events. While the initiative and pop-ups were announced on the Queen’s Library and the W.D. Jordan Library’s Instagram accounts, a more strategic marketing approach could have improved attendance at the second event for increased engagement with the rare medical texts. With this lack of extensive social media promotion, the hashtag, however captivating it was intended to be, did not garner any attention or traction. With the immense success of the colouring book, budgeting for subsequent print runs with long-term sustainability in mind would have been beneficial. In the wake of budget restraints and financial uncertainties, funds for resources may become strictly administered making it challenging to build a case for a de-stress activity, no matter the popularity and enthusiasm expressed for it.
Recommendations
Developing a five-year plan that outlines evaluation, promotion, and budget is recommended to ensure longevity. In the case of the Ol’ Medical Colouring Book, it was designed for long-term use as a standalone object with the possibility of ensuing editions. For those embarking on a similar wellness endeavour, a needs assessment is an ideal starting point for determining the needs of the users and in determining potential costs, time, and human resources required. This will also better position the library to improve student outcomes through well-planned and coordinated initiatives (Bladek, 2021). Alternatively, soliciting student feedback during distribution of the colouring books can provide a better understanding of student perceptions of the initiative and generate ideas for additional methods to support student wellness during and beyond the exam season. Partnerships with campus services and student groups can also increase participation and feedback. Developing a budget and securing funds for a set period is also recommended.
Conclusion
A beloved pastime with a student-centred spin
While the benefits of colouring are plentiful and detailed within the research literature, there has not been a publication on a colouring book initiative produced by a library since the trend ebbed around 2017. For this reason and owing to elements of its conception and execution, the Ol’ Medical Colouring Book is a unique output within the context of play-based initiatives. Its success is owed to the creative vision of a second-year history student who successfully transformed historical images into a tangible product to be traced, coloured, and otherwise altered. The semester-long internship co-supervised by librarians at separate libraries provided valuable experiential learning for an undergraduate student seeking a diverse range of opportunities within a cultural institution. The acquisition of both a print and digital ISBN provides the intern with their first official publication and unlocks the potential for subsequent editions using the existing colouring book as a template. The pop-up events enabled the librarians to connect and interact with the university community to help situate the colouring book within its historical context while also sharing insight into the collections and services provided by the library. While serving as a study break activity in and of itself, the mental health tips serve as a reminder to take important micro-breaks from work and study to support well-being. When combined, these distinct features of the colouring book allow it to serve as both a mindfulness tool for students and a valuable vehicle for librarian outreach efforts.
Future of the Ol’ Medical Colouring Book
The colouring book was on its fourth print run with only a single remaining copy ahead of the 2024 Fall exam period. While the success of the colouring book is determined predominantly through observation, it is evident that adult colouring remains a favourable pastime and an effective micro-break de-stress activity. The librarians have discussed the possibility of working with both arts and health sciences faculty to create subsequent editions for leisure and for learning. It is their hope that the Ol’ Medical Colouring Book will remain a positive library experience supporting wellness and inspiring curiosity for years to come.
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