Jasmine Gonzalvo, PharmD, MPH, CDCES, FADCES, joins this episode to discuss the importance of curiosity, effective communication and cultural sensitivity in diabetes care. She shares her personal approach to exploring barriers to insulin in clients and highlights how motivational interviewing can be a powerful tool in navigating treatment conversations—especially when addressing common misconceptions about insulin. The conversation emphasizes the importance of open-ended questions, recognizing personal biases, and creating safe spaces for honest dialogue. By nurturing relationships and meeting patients where they are, diabetes care and education specialists can better support lasting behavior change and improve health outcomes.
Jasmine Gonzalvo, PharmD, MPH, CDCES, FADCES, joins this episode to discuss the importance of curiosity, effective communication and cultural sensitivity in diabetes care. She shares her personal approach to exploring barriers to insulin in clients and highlights how motivational interviewing can be a powerful tool in navigating treatment conversations—especially when addressing common misconceptions about insulin. The conversation emphasizes the importance of open-ended questions, recognizing personal biases, and creating safe spaces for honest dialogue. By nurturing relationships and meeting patients where they are, diabetes care and education specialists can better support lasting behavior change and improve health outcomes.
This episode is sponsored by Lilly.
Resources
A link to the insulin myths tip sheet mentioned in this episode is coming soon.
References
Nahid Dehghan-Nayeri, Fatemeh Ghaffari, Tahereh Sadeghi, Naser Mozaffari; Effects of Motivational Interviewing on Adherence to Treatment Regimens Among Patients With Type 1 Diabetes: A Systematic Review. Diabetes Spectr 1 May 2019; 32 (2): 112–117.
Guy E H M Rutten, Heidi Van Vugt, Eelco de Koning - Person-centered diabetes care and patient activation in people with type 2 diabetes: BMJ Open Diabetes Research & Care 2020;8:e001926.
Entwistle VA, Carter SM, Cribb A, McCaffery K. Supporting patient autonomy: the importance of clinician-patient relationships. J Gen Intern Med. 2010 Jul;25(7):741-5. doi: 10.1007/s11606-010-1292-2. Epub 2010 Mar 6. PMID: 20213206; PMCID: PMC2881979.
Jodi Lavin-Tompkins
Hello and welcome to ADCES's podcast, The Huddle, conversations with the diabetes care team. In each episode, we speak with guests from across the diabetes care space to bring you perspectives, issues, and updates that elevate your role, inform your practice, and ignite your passion. I'm Jody Lavin-Thomkins, Director of Accreditation and Content Development at the Association of Diabetes Care and Education Specialists.
I'd like to take a moment to thank Lilly for their support of this podcast. My guest today is Jasmine Goncalvo. She's a PharmD and Director of the Center for Health Excellence, Quality and Innovation, and a clinical professor in the College of Pharmacy at Purdue University. She's also a clinical pharmacy specialist in primary care at an FQHC for Eskenazi Health in Indianapolis, Indiana.
In this episode, we'll have a conversation around insulin and engaging in productive conversations and navigating a wide array of barriers. Welcome to the Huddle, Jasmine.
Jasmine Gonzalvo
Thanks for having me today, Jodi.
Jodi Lavin-Tompkins
Before we dive in, could you share with our listeners a bit more about your background and how your experience relates to today's topic?
Jasmine Gonzalvo
Sure, Jodi, I always like to start off with my why and why I care about these topics and why I really just have an invested interest in these topics and what my experience is. And so really there are three things about me that really play a role in my passion and commitment to this topic. And number one is I'm the daughter of immigrants and being raised by a daughter of immigrants. I know firsthand about immigrants who struggle in this country to really make a life for themselves and my parents who immigrated from the Philippines really instilled values in me to be hardworking, to care for the community and really to be open minded about people's struggles and seeing humanity from a very compassionate lens. So that's one of my whys. A second one is I've been working for almost 20 years in a patient population or a population with people with diabetes who for the underserved hospital in our area. And that means, you know, a lot of them speak Spanish. The clinic that I practice in is actually 85 % Spanish speaking.
And most, if not all, are underinsured or uninsured. And that experience has really given me a commitment to seeing people's barriers, seeing people's hardships, and really going above and beyond to help navigate some of those barriers that get in the way of optimizing health.
And then thirdly, I myself, I'm a cancer survivor and having to navigate the health system with all of the barriers that come into play really opened my eyes to a lot of what people are facing. And I myself stand in a place of privilege and still had barriers navigating care, still do have barriers navigating care. all three of those really contribute to my why and how I show up to practice, how I show up for people with diabetes and how I show up for people that really are diverse and come from different backgrounds and have a number of barriers that stand in the way of optimizing health. So that's really where I'm coming from and why this topic really matters to me a lot, Jodi.
Jodi Lavin-Tompkins
Well, thank you for sharing your personal story too. And all of us have issues navigating health care, I think. But I mean, since the people you work with are so diverse, I'm wondering what your general approach is in working with them. Obviously, you have a lot of experience with that. And I would love for you to share that.
Jasmine Gonzalvo
Right, my general approach is really focused on effective communication and person-centered care. Number one, thankfully I can speak English and Spanish, so knocking down any language barriers that I have with a large portion of my Spanish-speaking population with whom I work, I think is a number one priority benefit of working with people because it really just gets one language barrier out of the way. Typically working with people, I prioritize effective communication, motivational interviewing, and really person-centered care to optimize care. And one of the things, for example, is someone's treatment plan, right? So if we're thinking about options and presenting options from the lens of a motivational interviewing, kind of style, we would say you have the option to continue taking the medications that you're currently on. And what we would expect from that plan is that your blood sugars would stay about the same. Another option would be to add insulin to your treatment plan. And that would, what we would expect from adding insulin would be a decrease in your sugars slowly over time if we were able to find a dose that really got your sugars to a healthy level. So something like that where we're presenting options for people instead of just kind of really throwing options at people or throwing this is what commands at people of what you're supposed to do, what you have to do, I think is an approach that has worked for me in working with people with diabetes.
That type of approach, I think, has allowed for a safe space where we can build rapport, we can build trust. And what I found is that the people with whom I'm working feel safe to ask questions and feel safe to say, no, I'm not ready for that step at this point. And that type of relationship, I think, really fosters some effective behavior change when we're talking about decisions to, for example, start insulin or start any medication really and supporting trust, rapport, safety in our space is something that I found effective.
Jodi Lavin-Tompkins
Communication is really important. And I'm interested in what types of discussions you're having with people around specifically using insulin. Because I imagine there's some common concerns that people bring up, as well as - you've mentioned this already - a variety of cultural and religious beliefs that you would need to address. And it would be great if you have a couple of examples you could share with our audience as well.
Jasmine Gonzalvo
I think when it comes to diversity and appreciating people's cultural backgrounds that really influence some of their decision making when it comes to taking medications, taking insulin, the approach that has been helpful for me is to ask a lot of questions. I really want to get a good sense of what are their personal and contextualized barriers that really produce fear, produce anxiety, and serve as barriers to taking whatever next step for their treatment plan. So asking a lot of questions, I might ask, can you tell me if you, do you know anybody taking insulin? Have you had family members taking insulin? Tell me about what you know from their experience, right? And that really just contextualizes, creates some depth to the barrier, right?
And once we can identify what the barriers are, then we can talk through those barriers and see what the best options are for people. Maybe someone might also say, well, and I've heard this with some of the people with whom I'm working, someone literally said, my mom died in the hospital because she was taking insulin. And I reflected something back. said, can you tell me a little bit more about what happened if you don't mind sharing, right? And it really did seem like she had really attributed her mom's negative experience with taking insulin. And what we were able to explore was I said, I asked more questions, of course. And by the end of the conversation, we really got to me being curious and me asking a lot of questions to say, I wonder if it was more her diabetes and more her sugars that were really harming her health and really were ultimately the reason she was in the hospital more so than it was the insulin. So we really created some background and some richness to the narrative that she followed along with every step of the way. And when we sort of rationalized and put together that story, it ended up making a lot more sense. And I didn't do that with the agenda of getting her on insulin. I did it with the agenda of understanding her narrative, her thoughts, her barriers. And ultimately she ended up making the decision to get on insulin. But again, I wasn't trying to push my agenda on her. I was really trying to understand the root of her fear with the idea that the insulin really was the most effective option for her at that point. And I think a lot of cultures, a lot of communities, a lot of populations may come with, for example, they may have tribes, they may have family members who really play a larger role in decision making for the treatment plan, right? So maybe it's, maybe as the diabetes care and education specialist, you say, is this something that we can revisit in a few weeks after you've talked to your tribe, after you've talked to your family that you'd feel more comfortable making a decision, right? And allowing and creating that safe space for that broader decision making. The other thing that may come up is some of maybe tendencies for traditional or more holistic practices, right? And again, creating a safe where that, a space where that's safe. It's safe to respect that, to give credit to that because that person wholly believes in perhaps something that's very different from Western medicine, right? And allowing the safe space to say, can you tell me a little bit more about that practice in particular? And can you tell me how that practice influences your sugars, for example, right? And setting that context, Jodi, I think has been really helpful in creating helpful conversations and potentially getting to the point where someone is more comfortable taking the next step with their treatment plan and that may be starting insulin in some cases.
Jodi Lavin-Tompkins
Well, I think I love what you said. And I think if I had to summarize it, it would be stay curious. yes, yes, stay curious.
Jasmine Gonzalvo
Yes, absolutely, Jodie. For all situations in life, stay curious.
Jodi Lavin-Tompkins
Do you mention insulin early on to kind of get them used to the idea so that later on when it comes up, they're not as afraid or shocked or whatever. mean, do you, I guess.
Jasmine Gonzalvo
If I'm teaching diabetes class, or if really if I'm working with anyone, I'm always asking, what is your understanding of diabetes? And shortly after that, after we talk about some diabetes basics, we also talk about the options for the treatment plan, right? And I put insulin front and center there as well, because I also think that it's important to talk about what people's thoughts and perceptions are about insulin, regardless of when they may or may not need it in their treatment plan, right? So I do tend to be pretty proactive and upfront with talking about insulin and educating about insulin upfront.
Jodi Lavin-Tompkins
All right. Well, I'm wondering if you could talk about some of the other strategies that have worked for you when there are gaps in knowledge or misperceptions that people have about taking insulin to ensure that they feel comfortable.
Jasmine Gonzalvo
Absolutely, so I'll reiterate that asking questions, asking questions first to understand what the gaps or the misconceptions are, Jodi, right? So I, as the diabetes care and education specialist, I as the pharmacist, I really want to have a good sense of what is that barrier? don't wanna guess at what the barrier is. I wanna be able to see it from a broader lens that incorporates all of the fears, anxieties that the person's having, right? So one of the things that I use that's a part of motivational interviewing as well is asking for permission. So for example, if somebody shares something that's incorrect, a fact that's incorrect about insulin, I may say, do you mind if I share with you some additional information about insulin, right? So it doesn't... Again, it doesn't threaten them by saying, no, that's not right. It just says, it just allows again, kind of an open door to say, do you mind if I share with you some information about insulin to go along with what you said, right? So asking for permission, again, maintains that safe space and doesn't put somebody on the defensive. So that's something that I do in particular to communicate in an open way. I also ask what the person's preferences are. So oftentimes as a clinician, there may be a few options that are available for somebody's treatment plan, right? It's not always the same thing, but it's always one thing or another, even given, for example, the same A1C, right? There are still a number of options. so I often, again, in the idea of presenting options and contextualizing everything, I ask what the person's preferences are for moving forward. So for example, knowing that your blood sugars have really been in the mid-200s lately, what do you feel comfortable as the next step for your treatment plan? And then I pause, right? And then they could say anything there. They could say, I don't wanna do anything, I want to increase one of my oral medicines. I want to start insulin. They can say anything there. And as the clinician, as the diabetes care and education specialist, I think it's really important to ask that question. What do you want to do? What are your thoughts? Because people surprise me, actually. And most of the time, they actually say something that makes a lot of sense to me and that I probably would also pick for them if they ask me to pick, right? So I think that creating that space and giving the person the autonomy to really define the next steps in their treatment plan, I think is really effective and I've seen it be effective in the way that when I work with people as well, Jodi.
Jodi Lavin-Tompkins
Sure, and I want to mention too that even though you have to individualize the strategies and so forth, but there are some common misconceptions. And we are creating a tip sheet that will be available in a link to it in the show notes that if anyone in the audience needs a tool to kind of start the discussion with someone,
It might be useful. So I just wanted to mention that.
Jasmine Gonzalvo
Yeah, Jodi, and I've looked at the tip sheet and it does have great FAQs and tips that really may help you and point you in the right direction in terms of finding the right words to say sometimes in some of those difficult conversations. And so I agree. The tip sheet can be a helpful tool for you in your toolbox.
Jodi Lavin-Tompkins
Yes, and I think we're about to wrap up now and I wanted to get any of your closing thoughts. I did want to just reiterate though a lot of what you said is to use open-ended questions in these conversations. I mean that's a motivational interviewing technique that works. So what else do you have to say in closing?
Jasmine Gonzalvo
You know, it's interesting, Jodi, that you say that because for my students sometimes, so people who are learning, and I'll get to my closing thoughts, promise. So one of the things when people are starting out with motivational interviewing and haven't been accustomed to always asking open-ended questions, sometimes, Jodi, I actually say, use a closed-ended question if you have to. So I don't like when people get stuck and have an awkward pause and silence and they're like, I'm looking, I'm searching, I'm searching for an open-ended question, I only have a closed one. And sometimes I just give them the escape of just ask your closed-ended question, you'll be okay, right? So I think that that's funny. A question, right, right, right, right. You're staying curious and I think that that's a nice segue into my closing thoughts, Jodi, of...
Jodi Lavin-Tompkins
At least you're asking a question, right? You're staying curious. Yeah.
Jasmine Gonzalvo
staying curious about the differences. When you have a reaction to someone's, to whatever your interaction may be with someone, whoever you're working with, with diabetes, I think sometimes it's very important to be mindful and to notice when you have a reaction. I am frustrated about their response. I am angry that they chose that. I don't think that's the best for them. I want us to pause and be mindful of those sort of feelings. There are own feelings that sometimes get in the way of how we work with and approach people. And staying curious, putting people first is really the way that I feel like I've been successful in the past. I think we need to recognize our own agenda, right? I want you to start insulin. But if I'm just pushing that on you and I haven't
been curious and I haven't explored and I haven't presented options, then it's unlikely that that person is just going to start insulin given all of their barriers or misunderstandings or lack of information, right? So staying curious, asking those questions, putting people first, recognizing your own agenda, working through your own biases that you may have to really be curious about what people's barriers are and why people might be apprehensive and providing those options tailored to their preferences. Sometimes it may be longer. You you may think I'm gonna go in here, I'm gonna start them on insulin, they're gonna come back in a few weeks and everything's gonna be perfect. That is not usually my experience of how people work. What I have found to be more successful, Jodi, really is this long game of nurturing a relationship and trust and safe space and then presenting options and allowing them to find out what is best for them and giving them the autonomy to choose their treatment plan, that has been most effective, Jodi.
Jodi Lavin-Tompkins
Okay, well that makes a lot of sense and Jasmine, thank you so much for taking the time to join us for this episode of the huddle and for sharing your expertise on this topic. And I think you gave our listeners some practical information they can use in their everyday practice.
Jasmine Gonzalvo
Thanks so much, Jodi. I've really enjoyed sharing my experiences and I appreciate the opportunity.
Jodi Lavin-Tompkins
And thank you all for listening to this week's episode of the huddle. Make sure to download the resources discussed in today's episode. You can find them linked in the show notes at adces.org forward slash podcast. And remember, ADCES membership gets you free access to resources, education, and networking that improve your practice and optimize outcomes for your clients.
Learn more about what ADCES can do for you at adces.org forward slash join. The information in this podcast is for informational purposes only and may not be appropriate or applicable to your individual circumstances. This podcast does not provide medical or professional advice and is not a substitute for consultation with a healthcare professional.
Please consult your healthcare professional for any medical questions.