The model of proactive care delivery is becoming a hot research topic. In China, the implementation of proactive care has revealed some problems, which may be due to unclear definition and connotation of proactive care, and unclear division of labor in various undertaking bodies. We combed the definition and connotation of proactive care, then analyzed and summarized the implementation status of proactive care in China. After that, we put forward implementation strategies for various undertaking bodies in accordance with the actual domestic conditions to improve the implementation effectiveness of proactive care to achieve universal health, and to move forward to the future of proactive care in China. The government should formulate a national proactive care plan, establish a proactive care promotion organization, regulate the cooperation between relevant departments, and optimize the community environment. Medical institutions should develop and implement health plans, prevent and treat diseases, and help the public to improve health literacy and develop healthy behavior and habits. Residents should develop healthy living habits according to the features of themselves and their families in a proactively and self-disciplined way. Relevant departments should take actions to promote stakeholders of proactive care resources to be engaged in proactive care implementation.
To improve people's health via meeting their growing health needs, the "Healthy China 2030" Planning Outline highlights the concept of protective care, and actively promotes the transformation from disease-centered care to human-centered care. There is still no a standard proactive care system. We summarized the essence, development status and significance of proactive care, then based on this, explored implementation strategies and assessment system regarding proactive care management conducted by community health institutions and community medical workers. We believe that community health institutions and community medical workers play an important role in the implementation of proactive care, and improving people's awareness of proactive care and self-health management ability via integrating proactive care into health management is of great significance to improve the national health level.
The Outline of the "Healthy China 2030" Plan points out improve the health literacy and lifestyle monitoring system covering the whole country, strengthen personal health responsibility, improve residents' self-health management ability and health level, in order to greatly improve the level of national health literacy. Scientific health literacy assessment tools can systematically understand the health literacy level of residents and provide targeted interventions. The health literacy assessment started late in China. The content of existing health literacy assessment tool should been improved, which is called Chinese Citizens' Health Literacy-Trial Implementation of Basic Knowledge and Skills (to try out), because it is definitely important to create an effective and reliable health literacy assessment tool.
Based on the perspective of active health, this paper reviews the relevant literature on health literacy assessment tools at home and abroad.
Chinese and foreign databases of PubMed, Web of Science, CNKI, Wanfang and VIP were systematically retrieved using keywords including "Health literacy" "Tool""Evaluation" "Assessment" "Questionnaire" "Scale". The related literature of health literacy assessment tools was obtained with the retrieval time from 1990-01-01 to 2021-06-30, and the current situation and contents of health literacy assessment tools were reviewed.
A total of 47 health literacy assessment tools were screened, including 27 objective assessment tools and 20 subjective assessment tools. The most of research and development (R&D) and application is in the United States (22) , followed by Europe (13) . The number of English tools is the largest (25) , followed by Portuguese (5) , Italian (3) and Spanish (2) . The evaluation time of REALM-SF, SILS is the shortest (1 minute) , and the longest for MHLS (25 minutes) . The least item is in SILS (1 item) , and REALM (125 items) has the most evaluated items. The most widely used evaluation tools are the REALM series scale and TOFHLA series scale in objective evaluation tools, and the HLS-EU-Q series scale in subjective evaluation tools. The evaluation mainly content involves vocabulary recognition, information acquisition, computing ability, reading comprehension, information exchange, information application and so on.
The development and application of health literacy assessment tools are dominated by European and American countries, and the number of objective health literacy assessment tools is in the majority. As the change of the connotation of health literacy from a single personal assessment to a comprehensive assessment of individuals and external environment, the R&D of health literacy assessment tools in China should be based on the establishment of unified standards across the country on the premise of deepening the connotation of health literacy and the concept of active health, the indicators should mainly be quantitative or semi quantitative indicators. A health literacy assessment tool suitable for China's national conditions covering the whole life cycle should be developed to provide scientific and effective support for improving the health literacy level of residents.
The prevention and treatment of colorectal cancer has become a societal concern. One key to colorectal cancer prevention and treatment is to improve the detection rate of colonoscopy screening, an essential tool for early diagnosis of colorectal cancer, in populations at high risk of colorectal cancer. Some research results show that the ability of individuals to make healthy choices and decisions is closely associated with their ability to acquire and understand information.
To investigate the association of health literacy level with colonoscopy screening compliance in an at-risk population identified by the first colorectal cancer screening.
Participants were individuals at risk of colorectal cancer selected from January to March 2020 who were identified by the general colorectal cancer screeningconducted by a community health center in Shanghai's Yangpu District during 2017—2018. General Demographic Information Questionnaire and the Chinese version of Health Literacy Management Scale (HeLMS-C) were used to conduct a questionnaire survey.
Altogether, 337 cases attended the survey, and 329 of them (97.6%) who handed in responsive questionnaires were finally included. Among the respondents, 252 had never received a colonoscopy, and only 77 had received that, with a colonoscopy screening compliance of 23.4%. The total average HeLMS-C score for the respondents was (103.77±3.78) . And the average scores of four domains of the scale, namely accessing GP healthcare services, communication with health professionals, patient attitudes towards their health, and social support were (44.50±1.70) , (36.34±2.10) , (15.83±2.01) and (7.09±1.37) , respectively. The distribution of marital status, type of risk for colorectal cancer identified by the first colorectal cancer screening, total score of the HeLMS-C, scores of accessing GP healthcare services, communication with health professionals and patient attitudes towards their health differed significantly between respondents who received a colonoscopy and those who did not (P<0.05) . Logistic regression analysis results showed that the type of marriage status, patient attitudes towards their health and communication with health professionals were associated with colonoscopy screening compliance (P<0.05) .
Having a spouse, higher patient attitudes towards their health, and higher level of communication with health professionals were associated with higher colonoscopy screening compliance in individuals at risk of colorectal cancer identified by the first colorectal cancer screening. In view of this, to improve the colonoscopy screening compliance of these people, attention should be paid to the improvement of the level of their health literacy.
