A cross-sectional study of health literacy and its association with non-communicable disease risk factors among retired Gurkha veterans in western Nepal

Health literacy strongly shapes health behavior and disease outcomes, yet little is known about it among retired veterans in low-resource settings. Retired Gurkha veterans of Nepal are one such ageing, underserved group, carrying a high burden of non-communicable disease (NCD) risk and facing particular difficulty in using civilian health services after leaving a structured military system. This study assessed multidimensional health literacy in this population and the non-communicable disease risks associated with it. We conducted a community-based cross-sectional study using face-to-face interviews with retired Nepali Gurkha veterans in Mathagadhi Rural Municipality, Palpa District, Nepal. Health literacy, measured as the nine HLQ domain scores, was the primary outcome (dependent variable); sociodemographic, military-service, behavioral and clinical characteristics, including the behavioral and metabolic NCD risk factors, were examined as its correlates. Associations with HLQ domains were tested with independent-samples t-tests and multivariate multiple linear regression. Health literacy was limited across several HLQ domains, lowest for navigating the healthcare system (mean 1.91, SD 0.77) and highest for social support (mean 3.56, SD 0.51). In bivariate analysis, older age and hypertension were associated with lower scores across all domains. In multivariate analysis, older age remained independently associated with lower health literacy, and normotensive participants (those with blood pressure below the hypertension threshold) scored consistently higher; diabetes and alcohol use showed no significant association. Retired Nepali Gurkha veterans show clear gaps in health literacy. Addressing them will require veteran-friendly, easier-to-navigate health services and stronger communication between veterans and their healthcare providers.