**Background:** Early reading interventions can improve language and literacy development in young children and enhance caregiver-child interactions. In low- and middle-income countries (LMICs), many children lack access to early childhood care and education programs, and the presence of children's books in households is sparse—only half of children in a 35-country MICS sample had a children's book at home. In rural Zambia, only approximately 30% of children have access to ECCE programs by age six, and a study in Lusaka found only 22% of households with grade 1 children owned a children's book. To address this gap, Zambian researchers developed a culturally representative, local language children's book targeted at pre-grade 1 children.
**Methods:** This qualitative study was conducted in four rural Zambian districts (Choma, Pemba, Kalomo in Southern Province; Nyimba in Eastern Province). Fifteen focus group discussions (FGDs) were held with 117 female caregivers who had received the "Zambian folktales adapted stories for young children" book. Participants were on average 33.1 years old (SD 10.4), had 7.5 years of education (SD 2.8), and 2.8 children (SD 1.2) under 10 years in the household; 81.2% were married or cohabiting. A codebook was created a priori based on established themes in the FGD guide, and content analysis was conducted in NVivo v12. Data were interpreted against the Theoretical Framework on Acceptability, which includes seven component constructs: affective attitude, ethicality, self-efficacy, intervention coherence, perceived effectiveness, burden, and opportunity costs.
**Key Results:** Respondents reported wide acceptability across multiple framework constructs. Affective attitude: Caregivers expressed very favorable views, noting children enjoyed the books and asked parents to read to them. The folktale nature connected readers with their culture and ancestry. Ethicality: Respondents valued the stories for teaching positive values and morals, including patience, respect, sharing, forgiveness, and hard work. Self-efficacy: The engaging pictures and local language writing made the book easy to use, even for less educated or illiterate caregivers. Intervention coherence: Caregivers used the book in one-on-one or group settings at home and in the community. Reading activities included asking children questions about the narrative or pictures, providing additional commentary, and children independently looking at pictures. Perceived effectiveness: Respondents believed the books were helping children grow vocabulary, develop speech, prepare for school, and learn social skills. Burden: The primary concern was the ability of low literacy caregivers to utilize the book; some households without a literate member declined the book. Suggested solutions included forming community reading groups. Opportunity costs: No themes arose for this construct.
**Clinical Implications:** This study demonstrates that a locally developed, culturally appropriate children's book can be widely accepted and utilized even in low-literacy, resource-limited settings. The book provided a platform for additional caregiver-child interactions through reading, dialogue, and oral storytelling—activities known to support language development and emergent literacy. The findings support the potential value of book distribution programs in LMICs, though the authors note that interventions combining book distribution with caregiver education on shared reading techniques may yield greater benefits. Future research should empirically evaluate the impact of such books on child developmental outcomes and assess the quality of shared reading experiences.