This scoping review examines the visual design elements of written patient information (WPI), specifically focusing on imagery, colour, layout and content presentation, and their impact on health information communication, understanding, behaviour and preferences among patients. Understanding patient preferences allows for patient-informed WPI design, which is important for Māori (Indigenous peoples of Aotearoa New Zealand) living in a colonial society. Nine studies were analysed, primarily investigating the integration of visual illustrations within WPI. Participants generally favoured the inclusion of images alongside text, finding them instrumental in enhancing comprehension and making health information more approachable. The preference for simpler and less detailed visuals, such as cartoons, was highlighted, although there was variability depending on literacy levels and cultural backgrounds. The use of colour, layout features (e.g. font type and white space) and content framing (e.g. positive versus negative framing of risk information) were explored for their effects on information reception and behavioural outcomes. Currently, there is a paucity of literature on Māori preferences and requires further research. Overall, this scoping review highlights the importance of designing WPIs with visual elements that cater to diverse literacy levels and cultural preferences to optimize communication effectiveness and patient engagement.