Health literacy and associated factors among adults in a rural mountain district of Nepal

Limited health literacy is a global public health concern and a key determinant of health outcomes, health service utilization, and health equity. Evidence on health literacy among the general adult population in Nepal remains limited, particularly in rural mountain areas. This study assessed the level of health literacy and its associated factors among adults in a rural mountain district of Nepal. A community-based cross-sectional study was conducted among 287 adults aged ≥ 18 years in Nasho Rural Municipality, Manang District, Nepal. Participants were selected using a multistage sampling technique. Health literacy was measured using the European Health Literacy Survey Questionnaire (HLS-EU-Q16), which demonstrated good internal consistency in this study (Cronbach’s α = 0.967). Bivariate and multivariable logistic regression analyses were performed to identify factors associated with limited health literacy. Overall, 77.7% of participants had limited health literacy, while 22.3% had adequate health literacy. Limited health literacy was most prevalent in the disease prevention domain. In multivariable analysis, lower odds of limited health literacy were observed among participants from Dalit ethnicity (AOR = 0.09; 95% CI 0.01–0.73), those who were literate (AOR = 0.14; 95% CI 0.02–0.81), participants engaged in business (AOR = 0.26; 95% CI 0.09–0.77), students (AOR = 0.21; 95% CI 0.05–0.88), and those whose primary source of health information was family or friends (AOR = 0.27; 95% CI 0.09–0.83). A high proportion of adults in a rural mountain district of Nepal had limited health literacy. Education, occupation, ethnicity, and primary source of health information were significantly associated with health literacy. Context-specific and community-based interventions are needed to improve access to understandable and reliable health information in rural settings.