Background <p>Evidence shows that the health literacy (HL) needs of adolescents in Nepal remain to be explored. Therefore, this baseline cross-sectional study aims to examine the HL needs of school adolescents to support the development of an intervention to improve adolescent health literacy.</p> Methods <p>This study included 501 ninth-graders from four community schools in Birendranagar Municipality, Surkhet, Nepal. The Nepali version of the HLS-Child-24-Nep scale was used as the data collection tool, which was adapted from the HLS- CHILD-15, covering four HL dimensions: accessing, understanding, appraising, and applying health information across three health domains: healthcare, disease prevention, and health promotion.</p> Results <p>The results revealed a significant lack of HL awareness among adolescents; the majority of participants were unfamiliar with the concept, and only a small proportion were aware of the consequences of poor HL, a key need identified in the study. Additionally, a significant portion demonstrated low to moderate levels of HL, which constituted a second key need. Additionally, participants’ struggles in the health promotion domain were more prevalent compared to healthcare and disease prevention. The results of the perceived difficulty level associated with HL dimensions and health domains showed similar and multi-dimensional challenges that are common among adolescent students.</p> Conclusion <p>The present study highlights the consistent and multidimensional HL needs among Nepalese adolescent students. It suggests the need to implement multidimensional interventions to effectively address these needs.</p>