Erin McMahon

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Journals/Publications

• Huang, S., Ash, G. I., Cao, J., D'Eramo Melkus, G., Nam, S., Jeon, S., McMahon, E., & Whittemore, R. (2025). Self-Reported Physical Activity in Chinese American Immigrants with a History of Gestational Diabetes Mellitus. Journal of Cardiovascular Nursing. doi:10.1097/jcn.0000000000001197
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  Background Women with a history of gestational diabetes mellitus (GDM) have an elevated risk for cardiometabolic diseases. Chinese American immigrants are disproportionately affected by GDM, yet their cardiometabolic risk factors are understudied. Little is known about physical activity (PA) of this understudied high-risk minority group. Objective The purpose of this study was to describe self-reported PA and the facilitators of and barriers to PA in Chinese American immigrants with a history of GDM. Methods We conducted an exploratory multimethod study between 2020 and 2021 among 106 Chinese American immigrant women. PA was self-reported using the International Physical Activity Questionnaire - Long form. Four domains of PA (work, transportation, housework, and leisure time) and daily sitting time were recorded. Open-ended questions were asked about the facilitators of and barriers to PA. Results Participants' mean age was 34.3 ± 3.7 years, and body mass index was 21.7 ± 2.6 kg/m2. Approximately 25% had low PA. Over half (N = 56, 53%) reported no leisure-time moderate-to-vigorous PA. Walking and housework were the most common types of PA. Barriers to PA included being busy with life, physical health issues (eg, sleep and postpartum health issues), low motivation or not enjoying PA, COVID-related barriers, and an unfavorable environment for PA. Conclusions Strategies are needed to increase leisure-time moderate-to-vigorous PA in this population. Modifiable factors include providing convenient PA programs (eg, technology or home-based) and addressing postpartum health issues (eg, sleep). Increasing providers' awareness of barriers to PA and cardiometabolic disease risk in this hard-to-reach, high-risk group may improve assessment and referral for high-risk women. Future research is needed to further explore opportunities for PA that Chinese American immigrant women would be open to at this stage in their life.
• McMahon, E., Huang, S., Nam, S., & Ash, G. (2024).

  Study Recruitment, Retention, and Adherence Among Chinese American

  Immigrants During the COVID-19 Pandemic. 

  . Nursing Research, 73(4), p. 328-336.
• Huang, S., Nam, S., Ash, G. I., Wu, B., Melkus, G. D., Jeon, S., McMahon, E., Dickson, V. V., & Whittemore, R. (2024). Study Recruitment, Retention, and Adherence Among Chinese American Immigrants During the COVID-19 Pandemic. Nursing Research, 73(Issue 4). doi:10.1097/nnr.0000000000000731
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  Background: Chinese American immigrants have been underrepresented in health research partly due to challenges in recruitment. Objectives: This study aims to describe recruitment and retention strategies and report adherence in a 7-day observational physical activity study of Chinese American immigrants with prior gestational diabetes during the COVID-19 pandemic. Methods: Foreign-born Chinese women aged 18–45 years, with a gestational diabetes index pregnancy of 0.5–5 years, who were not pregnant and had no current diabetes diagnosis were recruited. They wore an accelerometer for 7 consecutive days and completed an online survey. Multiple recruitment strategies were used: (a) culturally and linguistically tailored flyers, (b) social media platforms (e.g., WeChat [a popular Chinese platform] and Facebook), (c) near-peer recruitment and snowball sampling, and (d) a study website. Retention strategies included flexible scheduling and accommodation, rapid communications, and incentives. Adherence strategies included a paper diary and/or automated daily text reminders with a daily log for device wearing, daily email reminders for the online survey, close monitoring, and timely problem-solving. Results: Participants were recruited from 17 states; 108 were enrolled from August 2020 to August 2021. There were 2,479 visits to the study webpage, 194 screening entries, and 149 inquiries about the study. Their mean age was 34.3 years, and the mean length of U.S. stay was 9.2 years. Despite community outreach, participants were mainly recruited from social media (e.g., WeChat). The majority were recruited via near-peer recruitment and snowball sampling. The retention rate was 96.3%; about 99% had valid actigraphy data, and 81.7% wore the device for 7 days. The majority of devices were successfully returned, and the majority completed the online survey on time. Discussion: We demonstrated the feasibility of recruiting and retaining a geographically diverse sample of Chinese American immigrants with prior gestational diabetes during the COVID-19 pandemic. Recruiting Chinese immigrants via social media (e.g., WeChat) is a viable approach. Nonetheless, more inclusive recruitment strategies are needed to ensure broad representation from diverse socioeconomic groups of immigrants.
• Huang, S., Ash, G. I., Nam, S., Jeon, S., McMahon, E., & Whittemore, R. (2022). Objectively-Measured Physical Activity and Sedentary Behaviors and Related Factors in Chinese Immigrants in the US with Prior Gestational Diabetes Mellitus. International journal of environmental research and public health, 19(18).
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  Chinese immigrants in the US are disproportionately affected by gestational diabetes mellitus (GDM) and type 2 diabetes (T2D). The aims of this study were to describe their physical activity (PA) and sedentary behaviors (SB) patterns and to identify determinates of objectively-measured PA and SB among Chinese immigrants in the US with prior GDM. We conducted a cross-sectional study among 106 Chinese immigrants with prior GDM across the US. PA and SB were measured by GT9X+ hip accelerometers for 7 consecutive days. Validated questionnaires in English and Chinese were used to assess knowledge and risk perceptions as well as cultural and psychosocial characteristics. Descriptive, bivariate, and multiple regression analyses were performed. Only 27% of participants met the PA guidelines. The median duration of moderate-vigorous-intensity PA (MVPA) per week was 79 (IQR 38-151) minutes. Participants had an average of 9.2 ± 1.4 h of sedentary time per day. Living with parents (who may provide family support) was associated with more MVPA minutes per week, more steps per day, and a greater likelihood of meeting PA guidelines. Higher levels of acculturative stress were associated with fewer MVPA minutes per week. Being employed and having a lower BMI were associated with more SB. Strategies are needed to increase MVPA among this high-risk group, including decreasing acculturative stress and increasing family support. Different strategies are needed to decrease SB among this population.
• Whittemore, R., Mcmahon, E., Magny-normilus, C., & Huang, S. (2022). Systematic Review of Lifestyle Interventions for Gestational Diabetes Mellitus in Pregnancy and the Postpartum Period.. Journal of obstetric, gynecologic, and neonatal nursing : JOGNN, 51(2), 115-125. doi:10.1016/j.jogn.2021.10.007
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  To examine the characteristics and effectiveness of lifestyle interventions for gestational diabetes mellitus (GDM) in pregnancy and the postpartum period to prevent Type 2 diabetes..We conducted searches in seven databases, including Ovid MEDLINE, CINAHL, Ovid Embase, Cochrane Central, Web of Science, Ovid PsycInfo, and ProQuest Dissertations and Theses for articles published from inception to January 2021..We included articles on controlled intervention studies in which researchers evaluated a lifestyle intervention provided during pregnancy and the postpartum period for women with or at risk for GDM that were published in English..Twelve articles that were reports of seven studies met the inclusion criteria. In some cases, more than one article was selected from the same study. For example, articles reported different outcomes from the same study. We extracted data with the use of a data collection form and compared and synthesized data on study design, purpose, sample, intervention characteristics, recruitment and retention, and outcomes..All seven studies focused on weight management and/or healthy lifestyle behaviors (diet and physical activity). Outcomes included glucose regulation, weight, lifestyle behaviors, and knowledge. The interventions varied in duration/dosage, strategies, and modes of delivery. In four studies, researchers reported interventions that had significant effects on improving glucose regulation and/or weight change. Some characteristics from the four effective interventions included goal setting, individualized care, and good retention rates. In the other three studies, limitations included low rates of participant retention, lack of personalized interventions, and limited population diversity or lack of culturally sensitive care..Lifestyle interventions provided during and after pregnancy to reduce the risk associated with GDM have the potential to improve outcomes. Health care counseling to promote healthy lifestyle behaviors related to the prevention of Type 2 diabetes is needed at different stages of maternity care for women with GDM. Additional high-quality studies are needed to address the limitations of current studies.
• Huang, S., Magny-Normilus, C., McMahon, E., & Whittemore, R. (2021). Systematic Review of Lifestyle Interventions for Gestational Diabetes Mellitus in Pregnancy and the Postpartum Period. Journal of obstetric, gynecologic, and neonatal nursing : JOGNN.
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  To examine the characteristics and effectiveness of lifestyle interventions for gestational diabetes mellitus (GDM) in pregnancy and the postpartum period to prevent Type 2 diabetes.
• McMahon, E., Jimenez, F. A., Lawrence, K., & Victor, J. (2021). Healthcare Simulation Standards of Best PracticeTM Evaluation of Learning and Performance. Clinical Simulation in Nursing, 58(Issue). doi:10.1016/j.ecns.2021.08.016
• McMahon, E. (2012). Pregestational diabetes with extreme insulin resistance: use ofU-500 insulin in pregnancy. PubMed, 120, 120; 439 - 442. doi:10.1097/AOG.0b013e31824fd27d
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  Background: Increased insulin requirements in pregnancy can hinder attainment of glycemic control in diabetic patients. U-500 insulin is a concentrated form of regular insulin that can be a valuable tool in the treatment of patients with severe insulin resistance.Case: A 24-year-old woman with pregestational diabetes mellitus experienced increasing insulin requirements during pregnancy, peaking at 650 units daily. The frequent, large-volume injections of standard-concentration insulin were poorly tolerated by the patient and resulted in nonadherence. She subsequently achieved glycemic control on thrice-daily U-500 insulin.Conclusion: Pregnancy exacerbates insulin resistance in diabetic patients, and these patients may require high doses of insulin. U-500 insulin is an effective alternative for patients with severe insulin resistance and should be considered for pregnant women with difficulty achieving glycemic control.
• McMahon, E., Jevitt, C., & Aronson, B. (2018). Evaluation of the McMahon Competence Assessment Instrument for Use with Midwifery Students During a Simulated Shoulder Dystocia. Journal of midwifery & women's health, 63(2), 221-226.
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  Intrapartum emergencies occur infrequently but require a prompt and competent response from the midwife to prevent morbidity and mortality of the woman, fetus, and newborn. Simulation provides the opportunity for student midwives to develop competence in a safe environment. The purpose of this study was to determine the inter-rater reliability of the McMahon Competence Assessment Instrument (MCAI) for use with student midwives during a simulated shoulder dystocia scenario.

Presentations

• McMahon, E. (2025, January 10th). Obstetric Skills for Emergency Providers in a Critical Access Hospital. 2 hour skills workshop (implemented 5 times for a total of 30 participants). White Mountain Regional Medical Center, Springerville AZ: Center for Rural Health.
• Erickson, E., & McMahon, E. (2024, April). A Layered Approach to Protecting Maternal Mental Health: More than Diagnosis & Referral.. Arizona Perinatal Improvement Summit. Phoenix, AZ: University of Arizona College of Medicine- Phoenix / OB/GYN Department..
• McMahon, E. (2019, March). Simulation as an effective teaching strategy to develop competence in nurse-midwifery students.. The Healthcare Simulation Network of CT, New Haven, CT.. The Healthcare Simulation Network of CT, New Haven, CT.: The Healthcare Simulation Network of CT, New Haven, CT..
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  Simulation as an effective teaching strategy to develop competence in nurse-midwifery students. Presented at the Healthcare Simulation Network of CT, New Haven, CT.
• McMahon, E. (2019, May). Raising the Bar: Simulation in Midwifery Education.. The American College of Nurse-Midwives (ACNM) Annual Meeting. The American College of Nurse-Midwives (ACNM) in Washington D.C.: The American College of Nurse-Midwives (ACNM).
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  Raising the Bar: Simulation in Midwifery Education. Presented at the ACNM Annual Meeting, Washington D.C.
• McMahon, E. (2019, November). Simulation facilitated by the bedside nurse.. Presented at the Yale New Haven Hospital Perinatal Conference, Orange, CT.. Yale New Haven Hospital Perinatal Conference, Orange, CT.: Yale New Haven Hospital Perinatal Conference, Orange, CT..
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  Simulation facilitated by the bedside nurse. Presented at the Yale New Haven Hospital Perinatal Conference, Orange, CT.
• McMahon, E. (2018, June). Strategies for charting, billing, precepting and providing great care all at the same time.. Yale School of Nursing Preceptor Workshop. Yale School of Nursing Preceptor Workshop, Orange, CT.: Yale School of Nursing Preceptor Workshop, Orange, CT..
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  Strategies for charting, billing, precepting and providing great care all at the same time. Presented at the Yale School of Nursing Preceptor Workshop, Orange, CT.
• McMahon, E. (2018, May). Simulation as an objective teaching strategy with midwifery students.. The American College of Nurse-Midwives (ACNM). The American College of Nurse-Midwives (ACNM) in Savannah, GA.: The American College of Nurse-Midwives (ACNM).
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  Simulation as an objective teaching strategy with midwifery students. Presented at the ACNM Annual Meeting, Savannah, GA.
• McMahon, E. (2016, September). Reducing Primary Cesareans. The American College of Nurse-Midwives (ACNM) Collaborative at St. Raphael's Campus. Yale School of Nursing 60th Anniversary of the Nurse-Midwifery Program, Orange, CT: Yale School of Nursing 60th Anniversary of the Nurse-Midwifery Program, Orange, CT.
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  Reducing Primary Cesareans ACNM Collaborative at St. Raphael's Campus. Presented at the Yale School of Nursing 60th Anniversary of the Nurse-Midwifery Program, Orange, CT
• McMahon, E. (2015, June). Simulation in Midwifery Education: A Collaborative Model.. The American College of Nurse-Midwives (ACNM) Annual Meeting DOME, Washington, DC. The American College of Nurse-Midwives (ACNM) Annual Meeting DOME, Washington, DC: The American College of Nurse-Midwives (ACNM) Annual Meeting DOME, Washington, DC.
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  Simulation in Midwifery Education: A Collaborative Model.Presented at the ACNM Annual Meeting DOME, Washington, DC.
• McMahon, E. (2014, May). Completing the circle of safety through competency-based education.. The American College of Nurse-Midwives (ACNM). The American College of Nurse-Midwives (ACNM), Denver, CO.: The American College of Nurse-Midwives (ACNM), Denver, CO..
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  Completing the circle of safety through competency-based education. Presented at ACNM Annual Meeting, Denver, CO.

Poster Presentations

• McMahon, E. (2017, June). Evaluation of the McMahon Competence Assessment Instrument and the Shoulder Dystocia Simulation Module for use with Nurse-Midwifery Students.. The International Congress of Midwives. The International Congress of Midwives, Toronto, Canada: The International Congress of Midwives, Toronto, Canada.
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  Evaluation of the McMahon Competence Assessment Instrument and the Shoulder Dystocia Simulation Module for use with Nurse-Midwifery Students. Poster presented at the International Congress of Midwives, Toronto, Canada.
• McMahon, E. (2008, June). Sweet Mamas: Group Prenatal Care for Women with Gestational Diabetes.. The Association of Women's Health, Obstetric and Neonatal Nurses. The Association of Women's Health, Obstetric and Neonatal Nurses, San Diego, CA.: The Association of Women's Health, Obstetric and Neonatal Nurses, San Diego, CA..
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  Sweet Mamas: Group Prenatal Care for Women with Gestational Diabetes. Poster presented at AWHONN, San Diego, CA.