Background <p>Persistent health-related inequalities highlight the role of educational institutions as key settings for health promotion, prevention, and equitable participation. Learners with chronic conditions are frequently confronted with mismatches between health-related needs and organizational conditions. The article aims to highlight the educational potential of the setting approach in order to adapt the concept for educational institutions. It focuses on how frameworks in educational settings can be designed in such a&#xa0;way that health-literate behavior is enabled and institutional responsiveness is systematically promoted.</p> Study design <p>A&#xa0;qualitative reconstructive study with 12&#xa0;learners with chronic conditions (epilepsy, type&#xa0;1 diabetes) was conducted. Using the documentary method, four types of health-literate behavior and context-dependent enabling conditions were reconstructed. Based on these findings, the setting approach is theoretically adapted by incorporating a&#xa0;performance-oriented literacy dimension.</p> Results <p>The study presents an analytical framework for health literacy promotion in educational settings. It integrates behavior, structural conditions, and literacy, and identifies the organizational conditions under which health-literate behavior is enabled, stabilized, or constrained. Self-determination, context sensitivity, and design orientation emerge as key enabling conditions.</p> Conclusion <p>Vulnerable groups especially benefit from responsive frameworks that do not merely assume health-literate behavior, but enable and stabilize it. Through the targeted adaptation of the setting approach in educational institutions, its pedagogical potential can be systematically tapped for holistic health promotion.</p>